Provider Demographics
NPI:1841631660
Name:ESCAJADILLO, ELIZABETH STEPHANY (PT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STEPHANY
Last Name:ESCAJADILLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 W 54TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2620
Mailing Address - Country:US
Mailing Address - Phone:814-864-0671
Mailing Address - Fax:
Practice Address - Street 1:1521 W 54TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2620
Practice Address - Country:US
Practice Address - Phone:814-864-0671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1533823Medicaid