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General NPI Number Information
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NPI Number | 1659883528
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Entity Type | Individual
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Provider Name | EMILY ROSE ELLERBROCK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 255 GLENDALE AVE STE 12
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City | SPARKS
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State | NV
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Zip | 89431-5777
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Country | US
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Telephone | 775-356-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 CORPORATE DR STE 400
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City | HOOVER
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State | AL
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Zip | 35242-5424
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 3657
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 62472
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-5346
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT016868
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP027858T
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License Number State | WV
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