Individual
ELISA DETLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1102 W SPRUCE ST, RAWLINS, WY 82301-5335
(307) 370-9175
Mailing address
1102 W SPRUCE ST, RAWLINS, WY 82301-5335
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
0825
WY
Other
Enumeration date
11/07/2019
Last updated
11/07/2019
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