Provider Demographics
NPI:1487753109
Name:ELLIOTT, STEVEN D (PT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:D
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:311 CONGRESS PKWY N
Practice Address - Street 2:SUITE 800
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1699
Practice Address - Country:US
Practice Address - Phone:423-744-0890
Practice Address - Fax:423-744-0849
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT7609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBS GROUP NUMBER
TN5441371Medicaid
TN5441371Medicaid