Provider Demographics
NPI:1417646795
Name:ELLIE PHILLIPS-BURDGE, LLC
Entity Type:Organization
Organization Name:ELLIE PHILLIPS-BURDGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELEANORA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS-BURDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-708-1110
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:NY
Mailing Address - Zip Code:13062-0265
Mailing Address - Country:US
Mailing Address - Phone:607-708-1110
Mailing Address - Fax:607-708-1130
Practice Address - Street 1:116 WOOD RD
Practice Address - Street 2:
Practice Address - City:FREEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13068-9752
Practice Address - Country:US
Practice Address - Phone:607-708-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty