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Individual

ELISE D ETHRIDGE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DPT

Contact information

Practice address
4908 GREAT RIVER DR, MERIDIAN, MS 39305-2663
(601) 453-3632
(604) 453-3633
Mailing address
8205 PRESIDENTS DR, HUMMELSTOWN, PA 17036-8621
(717) 839-2188
(717) 565-1104

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT6687
MS

Other

Enumeration date
08/02/2019
Last updated
08/02/2019
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