Provider Demographics
NPI:1386068245
Name:STAINES, ELIZABETH R (PT)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:R
Last Name:STAINES
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 1:103 HICKORY MILL CT
Mailing Address - Street 2:
Mailing Address - City:LAKE WYLIE
Mailing Address - State:SC
Mailing Address - Zip Code:29710-8805
Mailing Address - Country:US
Mailing Address - Phone:803-981-4394
Mailing Address - Fax:803-746-5501
Practice Address - Street 1:410 FOILAGE CT
Practice Address - Street 2:
Practice Address - City:LAKE WYLIE
Practice Address - State:SC
Practice Address - Zip Code:29710-8838
Practice Address - Country:US
Practice Address - Phone:386-872-8029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-13
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist