Healthcare Provider Details

I. General information

NPI: 1427268945
Provider Name (Legal Business Name): ELLEN AMERICUS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 1 WHITSHED RD
CORDOVA AK
99574-3942
US

IV. Provider business mailing address

PO BOX 241889
ANCHORAGE AK
99524-1889
US

V. Phone/Fax

Practice location:
  • Phone: 907-424-3942
  • Fax: 907-424-3424
Mailing address:
  • Phone: 907-563-1777
  • Fax: 907-561-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPT05541
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: