Basic Information
Provider Information
NPI: 1033556196
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLANNERY
FirstName: ELIZABETH
MiddleName: ANNE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 ANDREA DR
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945965302
CountryCode: US
TelephoneNumber: 9257057872
FaxNumber:  
Practice Location
Address1: 100 ANDREA DR
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945965302
CountryCode: US
TelephoneNumber: 9257057872
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/30/2013
LastUpdateDate: 05/30/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 21751CAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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