Provider Demographics
NPI:1326624339
Name:STOLLER, ELLA KAY
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:KAY
Last Name:STOLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:IN
Mailing Address - Zip Code:46792-9402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:IN
Practice Address - Zip Code:46792-9402
Practice Address - Country:US
Practice Address - Phone:260-375-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant