1497126726 NPI number — ELISE TARRANT P.T., D.P.T.

Table of content: ELISE TARRANT P.T., D.P.T. (NPI 1497126726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497126726 NPI number — ELISE TARRANT P.T., D.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARRANT
Provider First Name:
ELISE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.T., D.P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497126726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 EL CAMINO REAL 420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURLINGAME
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94010-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-652-2376
Provider Business Mailing Address Fax Number:
650-652-9097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
126 GREENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAFAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94901-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-302-8344
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/13/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  42932 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)