Healthcare Provider Details

I. General information

NPI: 1619327343
Provider Name (Legal Business Name): ELLA MANTIPLY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLA MILLER

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15543 N REEMS RD STE 133
SURPRISE AZ
85374
US

IV. Provider business mailing address

15410 S MOUNTAIN PKWY STE 112
PHOENIX AZ
85044-6691
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-5374
  • Fax:
Mailing address:
  • Phone: 480-706-1161
  • Fax: 480-706-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305210325
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: