Provider Demographics
NPI:1053957597
Name:ELLER, STEVEN ROBERT (PTA12546)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ROBERT
Last Name:ELLER
Suffix:
Gender:M
Credentials:PTA12546
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 NE 14TH TER
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5703
Mailing Address - Country:US
Mailing Address - Phone:954-818-6338
Mailing Address - Fax:954-480-9082
Practice Address - Street 1:4917 NE 14TH TER
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5703
Practice Address - Country:US
Practice Address - Phone:954-818-6338
Practice Address - Fax:954-480-9082
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA12546225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant