Physician Compare National (NPI:1114256997)

HEALTHCARE PROVIDER: ELLEN HUMPHREY P.T.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1114256997
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749578516
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20161011001145
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HUMPHREY
	Individual professional last name
Provider First Name	ELLEN
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL THERAPY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	840 S WAUKEGAN RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 208
	Group Practice or individual's line 2 address
City	LAKE FOREST
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	600452619
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y