Healthcare Provider Details

I. General information

NPI: 1992750210
Provider Name (Legal Business Name): ELLEN M. TRUBEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1394 BATTLEFIELD PKWY
FORT OGLETHORPE GA
30742-4010
US

IV. Provider business mailing address

8007 HAMILTON MILL DR
CHATTANOOGA TN
37421-2760
US

V. Phone/Fax

Practice location:
  • Phone: 706-858-0252
  • Fax: 706-858-0323
Mailing address:
  • Phone: 909-553-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: