Provider Demographics
NPI:1568568038
Name:O'DONOGHUE, ELIZABETH ELLIOTT (MPT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ELLIOTT
Last Name:O'DONOGHUE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-2546
Mailing Address - Country:US
Mailing Address - Phone:202-486-4334
Mailing Address - Fax:
Practice Address - Street 1:5232 44TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2100
Practice Address - Country:US
Practice Address - Phone:240-400-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD180992251X0800X, 174400000X
DC29182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1452-0003OtherCAREFIRST
DCQ18242Medicare UPIN
DC014445M60Medicare ID - Type UnspecifiedMEDICARE