Provider Demographics
NPI:1528706629
Name:ELDER, ELIZABETH VICTORIA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VICTORIA
Last Name:ELDER
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 SWAN LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-7669
Mailing Address - Country:US
Mailing Address - Phone:407-448-1081
Mailing Address - Fax:
Practice Address - Street 1:116 E ALTAMONTE DR STE 108
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4301
Practice Address - Country:US
Practice Address - Phone:407-664-4249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA96216225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist