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Individual
GARY S. ELISES
Active
Individual
GARY S. ELISES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
04016
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04016
LICENSE
IA
Enumeration date
07/27/2007
Last updated
04/25/2022
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