Healthcare Provider Details

I. General information

NPI: 1962540047
Provider Name (Legal Business Name): ELLAINE THOMAS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 12/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 MAIDEN LN
NEW YORK NY
10038-4812
US

IV. Provider business mailing address

2 BROOKDELL DR
HARTSDALE NY
10530-1709
US

V. Phone/Fax

Practice location:
  • Phone: 212-780-2379
  • Fax:
Mailing address:
  • Phone: 914-320-8968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: