Provider Demographics
NPI:1538511472
Name:ELLIS, ERIKA (DPT)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 W 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1117
Mailing Address - Country:US
Mailing Address - Phone:509-251-1909
Mailing Address - Fax:
Practice Address - Street 1:1214 W 18TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1117
Practice Address - Country:US
Practice Address - Phone:509-251-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-04
Last Update Date:2016-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60638250225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist