Provider Demographics
NPI:1962475137
Name:FLETCHER III, ELIJAH (ATC)
Entity type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:
Last Name:FLETCHER III
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 ASHWORTH OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-3350
Mailing Address - Country:US
Mailing Address - Phone:305-301-7461
Mailing Address - Fax:
Practice Address - Street 1:700 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4419
Practice Address - Country:US
Practice Address - Phone:352-323-6642
Practice Address - Fax:352-323-5039
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator