Provider Demographics
NPI:1437206380
Name:ELA, MITZILYN (PT)
Entity type:Individual
Prefix:MS
First Name:MITZILYN
Middle Name:
Last Name:ELA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12603 214TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90715-2407
Mailing Address - Country:US
Mailing Address - Phone:562-484-3860
Mailing Address - Fax:562-684-4070
Practice Address - Street 1:13330 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3251
Practice Address - Country:US
Practice Address - Phone:562-484-3860
Practice Address - Fax:562-684-4070
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28854225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28854Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER