Basic Information
| Provider Information | |||||||||
| NPI: | 1154641934 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELLAS | ||||||||
| FirstName: | ELEAZAR | ||||||||
| MiddleName: | ELEGINO | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1284 TWILIGHT DR. | ||||||||
| Address2: | |||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707735123 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 578 COMMERCIAL ST. | ||||||||
| Address2: | |||||||||
| City: | MARSEILLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157955121 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2010 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.