Gary S. Elises, PHYSICAL THERAPIST
Individual provider Active NPI Physical Therapist · Pella, IA
NPI 1376733253 · NPPES record last updated Apr 25, 2022
Key facts
- NPI
- 1376733253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 04016 (IA)
- Practice address
- 405 Monroe St
Pella, IA 50219-1189 - Phone
- (641) 628-3832
- Fax
- (641) 628-8894
- NPI assigned
- Jul 27, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Elises Corp | Physical Therapist | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 04016 | IA | Yes |
Addresses
Primary practice location
405 Monroe St
Pella, IA 50219-1189
Mailing address
405 Monroe St
Pella, IA 50219-1189
Phone (641) 628-3832
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04016 | Other | IA | LICENSE |
Other providers in Pella, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 25, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.