Provider Demographics
NPI:1063756534
Name:HERLIHY, ELIZABETH A (DPT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:HERLIHY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:ALLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:80 TECHNACENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6028
Mailing Address - Country:US
Mailing Address - Phone:334-625-5795
Mailing Address - Fax:334-396-4905
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:678-719-7000
Practice Address - Fax:678-719-7003
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13638326OtherCAQH
GA202I652549Medicare PIN