Provider Demographics
NPI:1467528141
Name:JUZBA, ELLEN K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:K
Last Name:JUZBA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:K
Other - Last Name:MATUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST
Mailing Address - Street 2:360
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3581
Mailing Address - Country:US
Mailing Address - Phone:413-734-8440
Mailing Address - Fax:413-731-6703
Practice Address - Street 1:159 CROSSOVER ROAD
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518
Practice Address - Country:US
Practice Address - Phone:910-298-6455
Practice Address - Fax:910-298-6405
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA940225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant