Provider Demographics
NPI:1306541719
Name:JAFFREZO, ELISE (PTLA)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:JAFFREZO
Suffix:
Gender:F
Credentials:PTLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1334
Mailing Address - Country:US
Mailing Address - Phone:925-750-4966
Mailing Address - Fax:
Practice Address - Street 1:87 FENTON ST STE 106
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4159
Practice Address - Country:US
Practice Address - Phone:925-373-9394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist