Healthcare Provider Details

I. General information

NPI: 1992968945
Provider Name (Legal Business Name): TONYA ELLINGTON P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 JAMES SANDERS BLVD STE A
PADUCAH KY
42001-8405
US

IV. Provider business mailing address

401 INDIANA AVE
MAYFIELD KY
42066-1799
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-5114
  • Fax:
Mailing address:
  • Phone: 270-247-6537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001658
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberPT 001658
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: