Provider Demographics
NPI:1447377072
Name:ELSLANDER, JOHNITA
Entity type:Individual
Prefix:MRS
First Name:JOHNITA
Middle Name:
Last Name:ELSLANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CRYSTAL COURT CIR
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-7676
Mailing Address - Country:US
Mailing Address - Phone:501-362-8968
Mailing Address - Fax:501-362-7855
Practice Address - Street 1:2000 HIGHWAY 25B
Practice Address - Street 2:SUITE A-1
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-6417
Practice Address - Country:US
Practice Address - Phone:501-362-7195
Practice Address - Fax:501-362-7855
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1376225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant