Provider Demographics
NPI:1417378506
Name:SCHAWELSON, ELLEN R (LMT MT08801)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:R
Last Name:SCHAWELSON
Suffix:
Gender:F
Credentials:LMT MT08801
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 N. 95TH ST.
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-860-8998
Mailing Address - Fax:480-377-9245
Practice Address - Street 1:9913 N. 95TH ST.
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-860-8998
Practice Address - Fax:480-377-9245
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist