Provider Demographics
NPI:1962747899
Name:FENN, ELIZABETH S (PTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:FENN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10452 HIGHWAY 5
Mailing Address - Street 2:SUITE D
Mailing Address - City:BRENT
Mailing Address - State:AL
Mailing Address - Zip Code:35034-3923
Mailing Address - Country:US
Mailing Address - Phone:205-316-9207
Mailing Address - Fax:205-316-9208
Practice Address - Street 1:10452 HIGHWAY 5
Practice Address - Street 2:SUITE D
Practice Address - City:BRENT
Practice Address - State:AL
Practice Address - Zip Code:35034-3923
Practice Address - Country:US
Practice Address - Phone:205-316-9207
Practice Address - Fax:205-316-9208
Is Sole Proprietor?:No
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTA425225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant