Healthcare Provider Details

I. General information

NPI: 1851288914
Provider Name (Legal Business Name): PHILLIP ELLSWORTH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40975 N IRONWOOD DR STE C14
SAN TAN VALLEY AZ
85140-8906
US

IV. Provider business mailing address

40975 N ARBOR AVE
SAN TAN VALLEY AZ
85140-5416
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-3590
  • Fax: 480-359-2113
Mailing address:
  • Phone: 661-859-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-034221
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: