Provider Demographics
NPI:1427271279
Name:ELLIOTT, JENNIFER LEE (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:11530 BEATTIES FORD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8460
Mailing Address - Country:US
Mailing Address - Phone:704-519-7733
Mailing Address - Fax:980-343-5990
Practice Address - Street 1:11530 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8460
Practice Address - Country:US
Practice Address - Phone:704-519-7733
Practice Address - Fax:980-343-5990
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08902255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer