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Individual
BRIAN V ELSEMORE
Active
Individual
BRIAN V ELSEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
007571
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080007571CT01
BLUE SHIELD
CT
Enumeration date
04/25/2006
Last updated
10/29/2007
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