Provider Demographics
NPI:1902095623
Name:ELLIS, BARBARA HELEN (RPT)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:HELEN
Last Name:ELLIS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MERIDIAN ST N
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35811-1845
Mailing Address - Country:US
Mailing Address - Phone:256-852-5170
Mailing Address - Fax:256-858-8525
Practice Address - Street 1:2701 MERIDIAN ST N
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35811-1845
Practice Address - Country:US
Practice Address - Phone:256-852-5170
Practice Address - Fax:256-858-8525
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist