Individual
MAURICIO ELIZONDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, DPT, ATC, CSCS
Contact information
Practice address
201 ATP TOUR BLVD, PONTE VEDRA BEACH, FL 32082-3211
(480) 208-4508
Mailing address
16627 FISHHAWK BLVD, LITHIA, FL 33547-3800
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
PT33327
FL
Other
Enumeration date
11/05/2018
Last updated
11/08/2018
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