Provider Demographics
NPI:1124104948
Name:DRISKELL, ELAINE MARIE (RPT)
Entity type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:MARIE
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11830 CRESTHILL DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-9332
Mailing Address - Country:US
Mailing Address - Phone:916-682-8544
Mailing Address - Fax:
Practice Address - Street 1:9634 ELK GROVE FLORIN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2226
Practice Address - Country:US
Practice Address - Phone:916-685-8448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT11944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist