Provider Demographics
NPI:1215368592
Name:COLLARD, ELLEN (DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:COLLARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WAMPANOAG TRAIL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-1038
Mailing Address - Country:US
Mailing Address - Phone:401-433-4049
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:1525 WAMPANOAG TRAIL
Practice Address - Street 2:SUITE 205
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02915-1038
Practice Address - Country:US
Practice Address - Phone:401-433-4049
Practice Address - Fax:401-433-0612
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PT02650225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist