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General NPI Number Information
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NPI Number | 1720202088
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Entity Type | Individual
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Provider Name | MARYELLEN ERNST PT, CP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 28 NORFOLK AVE
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City | SWAMPSCOTT
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State | MA
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Zip | 01907-1805
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Country | US
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Telephone | 781-598-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 100B ROCKING HORSE ROAD SOUTHSHORE
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City | CHRISTCHURCH
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State | NEW ZEALAND
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Zip | 8062
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Country | NZ
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Telephone | 643-382-5556
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 8216
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License Number State | MA
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