MEDICARE: ABBY M ELLENBURG PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PTH4586	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51002181	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1548294713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY M ELLENBURG PT

Provider Business Mailing Address
First Line	:	2652 HAMPTON PARK CIR
Second Line	:
City	:	FOLEY
State	:	AL
Zip	:	36535-1130
Country	:	US
Telephone Number	:	251-971-6219
Fax Number	:	256-350-7757

Provider Business Practice Location Address
First Line	:	4223 ORANGE BEACH BLVD
Second Line	:	SUITE D
City	:	ORANGE BEACH
State	:	AL
Zip	:	36561-3459
Country	:	US
Telephone Number	:	251-981-1300
Fax Number	:	251-981-1305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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Directions to “ ABBY M ELLENBURG PT” Practice Location

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