Provider Demographics
NPI:1174968671
Name:IRELAND, ELIZABETH CARRIE (PTA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CARRIE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 HIGHWAY 159
Mailing Address - Street 2:
Mailing Address - City:NORTONVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66060-6002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2011 HIGHWAY 159
Practice Address - Street 2:
Practice Address - City:NORTONVILLE
Practice Address - State:KS
Practice Address - Zip Code:66060-6002
Practice Address - Country:US
Practice Address - Phone:913-360-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01575225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant