Individual
ELISE FENGLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
161 COLLEGE AVE, MEDFORD, MA 02155-5593
(617) 627-5102
(617) 627-2185
Mailing address
123 ORCHARD ST APT 4, SOMERVILLE, MA 02144-3036
(609) 610-1607
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, DEVLEOPMENTAL, REHAB AND RESTORATIVE SERVICE PROVIDERS
PA
Enumeration date
08/31/2015
Last updated
01/20/2023
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