Provider Demographics
NPI:1427784156
Name:ALVORD, KORAL ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:KORAL
Middle Name:ELIZABETH
Last Name:ALVORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 COUNTY ROAD 28
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IN
Mailing Address - Zip Code:46793-9426
Mailing Address - Country:US
Mailing Address - Phone:260-920-0915
Mailing Address - Fax:
Practice Address - Street 1:701 NORTH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1633
Practice Address - Country:US
Practice Address - Phone:260-908-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22207717225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty