Provider Demographics
NPI:1366518557
Name:ELDRIDGE, DENNIS RAY (DPT)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:RAY
Last Name:ELDRIDGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2726 GRIFFIN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-2362
Mailing Address - Country:US
Mailing Address - Phone:360-802-6757
Mailing Address - Fax:
Practice Address - Street 1:2726 GRIFFIN AVE STE C
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2362
Practice Address - Country:US
Practice Address - Phone:360-802-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA8219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB21067Medicare PIN