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NPI Code Detail

MEDICARE: ELLEN VAN WERT PT

MEDICARE: ELLEN VAN WERT 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
1225100000XPhysical Therapist24347MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710296918
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN VAN WERT PT
Provider Business Mailing Address
First Line : 465 WAVERLY OAKS RD STE 101
Second Line :
City : WALTHAM
State : MA
Zip : 02452-8497
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 465 WAVERLY OAKS RD STE 101
Second Line :
City : WALTHAM
State : MA
Zip : 02452-8497
Country : US
Telephone Number : 781-325-6180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2010
Last Update Date : 02/25/2022

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