Provider Demographics
NPI:1275801953
Name:ELLSWORTH, DONALD G (PTA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:ELLSWORTH
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Gender:M
Credentials:PTA
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Mailing Address - Street 1:3425 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5701
Mailing Address - Country:US
Mailing Address - Phone:719-265-6601
Mailing Address - Fax:719-265-6649
Practice Address - Street 1:3425 AUSTIN BLUFFS PKWY
Practice Address - Street 2:105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5701
Practice Address - Country:US
Practice Address - Phone:719-265-6601
Practice Address - Fax:719-265-6649
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2016-12-12
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant