MEDICARE: MR. DENNIS M. ELLINGSON P.T.

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
1	225100000X	Physical Therapist	PT6619	CA
2	225100000X	Physical Therapist	391	MT

General Provider Information

NPI Number	:	1508803024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS M. ELLINGSON P.T.

Provider Business Mailing Address
First Line	:	1802 7TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-3808
Country	:	US
Telephone Number	:	916-709-4911
Fax Number	:	916-441-4911

Provider Business Practice Location Address
First Line	:	1802 7TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-3808
Country	:	US
Telephone Number	:	916-709-4911
Fax Number	:	916-441-4911

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/08/2007

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