Provider Demographics
NPI:1417135229
Name:ELLSWORTH, WHITNEY MERDITH (DRPT)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:MERDITH
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:DRPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 N ASPEN AVE STE 1023
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1378
Mailing Address - Country:US
Mailing Address - Phone:918-486-9977
Mailing Address - Fax:539-777-2529
Practice Address - Street 1:2601 N ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1373
Practice Address - Country:US
Practice Address - Phone:918-486-9977
Practice Address - Fax:539-777-2529
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist