MEDICARE: ELLEN M. TRUBEY PT

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	PT29541	CA

General Provider Information

NPI Number	:	1992750210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN M. TRUBEY PT

Provider Business Mailing Address
First Line	:	8007 HAMILTON MILL DR
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-2760
Country	:	US
Telephone Number	:	909-553-7284
Fax Number	:

Provider Business Practice Location Address
First Line	:	1394 BATTLEFIELD PKWY
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-4010
Country	:	US
Telephone Number	:	706-858-0252
Fax Number	:	706-858-0323

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	06/26/2008

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