Provider Demographics
NPI:1043286131
Name:VENTURA, ELLY R (ATC/L)
Entity Type:Individual
Prefix:MRS
First Name:ELLY
Middle Name:R
Last Name:VENTURA
Suffix:
Gender:F
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:POULTNEY
Mailing Address - State:VT
Mailing Address - Zip Code:05764-0081
Mailing Address - Country:US
Mailing Address - Phone:518-642-1028
Mailing Address - Fax:802-468-2189
Practice Address - Street 1:190 COLLEGE DRIVE
Practice Address - Street 2:GLENBROOK GYM
Practice Address - City:CASTLETON
Practice Address - State:VT
Practice Address - Zip Code:05735
Practice Address - Country:US
Practice Address - Phone:802-468-1102
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00001182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer