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General NPI Number Information
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NPI Number | 1417646795
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Entity Type | Organization
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Legal Business Name | ELLIE PHILLIPS-BURDGE, LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 116 WOOD RD
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City | FREEVILLE
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State | NY
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Zip | 13068-9752
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Country | US
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Telephone | 607-708-1110
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 265
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City | ETNA
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State | NY
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Zip | 13062-0265
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Country | US
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Telephone | 607-708-1110
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Fax | 607-708-1130
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ELEANORA PHILLIPS-BURDGE
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Credential | PT
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Telephone | 607-708-1110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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