Provider Demographics
NPI:1316988827
Name:FORTENER, ELIZABETH MARIE (PT)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:MARIE
Last Name:FORTENER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 FALLS OF NEUSE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3550
Mailing Address - Country:US
Mailing Address - Phone:919-803-0738
Mailing Address - Fax:
Practice Address - Street 1:8470 FALLS OF NEUSE RD
Practice Address - Street 2:STE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3550
Practice Address - Country:US
Practice Address - Phone:919-803-0738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1997174400000X
NC11608225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509062Medicaid
NV100509062Medicaid