Healthcare Provider Details

I. General information

NPI: 1366107708
Provider Name (Legal Business Name): ELLYN WERTELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 CENTERVILLE RD BLDG A
WARWICK RI
02886-4353
US

IV. Provider business mailing address

535 CENTERVILLE RD STE 101
WARWICK RI
02886-4376
US

V. Phone/Fax

Practice location:
  • Phone: 401-384-6490
  • Fax: 401-384-6493
Mailing address:
  • Phone: 401-737-6011
  • Fax: 401-737-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT03251
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: