Individual
BRIAN DALE ELZA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
(505) 722-1310
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 722-1310
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
20290
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
762189
—
AZ
05
—
77003888
—
NM
Enumeration date
03/10/2006
Last updated
07/08/2007
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