Provider Demographics
NPI:1275879611
Name:EWING, ELLEN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:MARIE
Last Name:EWING
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 1:14106 WAINWRIGHT CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1738
Mailing Address - Country:US
Mailing Address - Phone:301-262-6864
Mailing Address - Fax:301-262-6864
Practice Address - Street 1:4061 POWDER MILL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705-3149
Practice Address - Country:US
Practice Address - Phone:301-957-5379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist