Provider Demographics
NPI:1992900245
Name:ELLIOTT, YVONNE L (PT)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:L
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2448 N MERRIT CREEK LOOP
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4953
Mailing Address - Country:US
Mailing Address - Phone:208-664-2901
Mailing Address - Fax:208-667-9266
Practice Address - Street 1:2448 N MERRIT CREEK LOOP
Practice Address - Street 2:SUITE 2A
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4953
Practice Address - Country:US
Practice Address - Phone:208-664-2901
Practice Address - Fax:208-667-9266
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPT 2213208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
82053495583814A009OtherTRIWEST/TRICARE
QMXPR0060660OtherMOLINA
DA3588OtherRAIL ROAD MEDICARE
32101OtherGROUP HEALTH
5003984OtherREGENCE MEDADVANTAGE
ID907605881Medicaid
185598800OtherFEDERAL L&I
ID4746230001OtherMEDICARE-DME
88753OtherFIRST CHOICE
IDTD895OtherBLUE CROSS
ID000010175553OtherBLUE SHIELD
262004OtherWA L&I
82-0534955OtherSTATE INS FUND
82-0534955OtherSTERLING
88753OtherFIRST CHOICE