Provider Demographics
NPI:1548456700
Name:SEIB, ELLEN M (PT)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:SEIB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-2067
Mailing Address - Country:US
Mailing Address - Phone:706-886-3883
Mailing Address - Fax:706-886-3812
Practice Address - Street 1:100 HAYES ST
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-2067
Practice Address - Country:US
Practice Address - Phone:706-886-3883
Practice Address - Fax:706-886-3812
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00817979AMedicaid
GA00817979AMedicaid