Basic Information
| Provider Information | |||||||||
| NPI: | 1770936981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELDER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | FRANCES | ||||||||
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| Credential: | LMT,RMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 SOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436093333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199845908 | ||||||||
| FaxNumber: | 4198723258 | ||||||||
| Practice Location | |||||||||
| Address1: | 28442 E RIVER RD STE 204205 | ||||||||
| Address2: | |||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435512795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199845908 | ||||||||
| FaxNumber: | 4198723258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2016 | ||||||||
| LastUpdateDate: | 07/22/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173C00000X | 33.023038 | OH | N | Other Service Providers | Reflexologist | 225700000X | 33.023038 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.