Provider Demographics
NPI:1164681631
Name:HECTOR, ELLEN WHELAN (PT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:WHELAN
Last Name:HECTOR
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 1:1225 NORTHWAY DR
Mailing Address - Street 2:APARTMENT #7
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-7921
Mailing Address - Country:US
Mailing Address - Phone:248-361-9693
Mailing Address - Fax:
Practice Address - Street 1:1660 HASLETT RD
Practice Address - Street 2:SUITE #4
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8469
Practice Address - Country:US
Practice Address - Phone:517-339-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist