Provider Demographics
NPI:1437761590
Name:DR. WHITNEY M. ELLSWORTH, DPT, PLLC
Entity Type:Organization
Organization Name:DR. WHITNEY M. ELLSWORTH, DPT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:918-486-9977
Mailing Address - Street 1:4185 S HARVARD AVE
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135
Mailing Address - Country:US
Mailing Address - Phone:918-486-9977
Mailing Address - Fax:539-777-2529
Practice Address - Street 1:4185 S HARVARD AVE
Practice Address - Street 2:SUITE E-1
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-486-9977
Practice Address - Fax:539-777-2529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200398390AMedicaid