Provider Demographics
NPI:1154063139
Name:PARHAM, ELLSWORTH (PT)
Entity Type:Individual
Prefix:
First Name:ELLSWORTH
Middle Name:
Last Name:PARHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 AYRSLEY TOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4220
Mailing Address - Country:US
Mailing Address - Phone:980-939-1580
Mailing Address - Fax:
Practice Address - Street 1:2064 AYRSLEY TOWN BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4220
Practice Address - Country:US
Practice Address - Phone:980-939-1580
Practice Address - Fax:980-939-1128
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist