Provider Demographics
NPI:1144724931
Name:MALONEY, ELLEN (DPT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 RIVER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-5412
Mailing Address - Country:US
Mailing Address - Phone:541-683-6187
Mailing Address - Fax:541-689-4525
Practice Address - Street 1:2401 RIVER RD STE 102
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5412
Practice Address - Country:US
Practice Address - Phone:541-683-6187
Practice Address - Fax:541-689-4525
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist