Basic Information
| Provider Information | |||||||||
| NPI: | 1598283970 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ETTER | ||||||||
| FirstName: | ELIZA | ||||||||
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| Credential: | PT, DPT, CLT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13950 BRANDYWINE RD | ||||||||
| Address2: | |||||||||
| City: | BRANDYWINE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206135815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017822250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 156 WILLIAM ST RM 800 | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100385347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122670240 | ||||||||
| FaxNumber: | 8669284144 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2017 | ||||||||
| LastUpdateDate: | 11/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01737200 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 27163 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 045071-1 | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 045071-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.