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NPI Code Detail

MEDICARE: ELIZABETH ELLIS

MEDICARE: ELIZABETH ELLIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical TherapistPT029800PA

General Provider Information

NPI Number : 1043987019
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ELLIS
Provider Business Mailing Address
First Line : 475 ALLENDALE RD STE 206
Second Line :
City : KING OF PRUSSIA
State : PA
Zip : 19406-1495
Country : US
Telephone Number : 610-270-0370
Fax Number :
Provider Business Practice Location Address
First Line : 1175 LANCASTER AVE
Second Line :
City : BERWYN
State : PA
Zip : 19312-1297
Country : US
Telephone Number : 610-651-8282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2021
Last Update Date : 08/26/2021

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Directions to “ ELIZABETH ELLIS ” Practice Location

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