Healthcare Provider Details

I. General information

NPI: 1184292617
Provider Name (Legal Business Name): ELLEN MERCHANT DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 FLETCHER PKWY
LA MESA CA
91942-3005
US

IV. Provider business mailing address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-0137
  • Fax: 619-460-0139
Mailing address:
  • Phone: 858-279-5570
  • Fax: 858-279-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT300183
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT032365
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: