Healthcare Provider Details

I. General information

NPI: 1871811182
Provider Name (Legal Business Name): BONNIE F ELLIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 05/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SAINT JOHNSBURY RD
LITTLETON NH
03561-3442
US

IV. Provider business mailing address

429 WHITEHILL RD
EAST RYEGATE VT
05042-8934
US

V. Phone/Fax

Practice location:
  • Phone: 603-444-9530
  • Fax: 603-944-9361
Mailing address:
  • Phone: 802-633-3580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0759
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: