Provider Demographics
NPI:1558513085
Name:ELLIS, DEBRA RUDNICK (MSPT, NCS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:RUDNICK
Last Name:ELLIS
Suffix:
Gender:F
Credentials:MSPT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 HEATHERSTONE RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1692
Mailing Address - Country:US
Mailing Address - Phone:413-695-6069
Mailing Address - Fax:423-665-9871
Practice Address - Street 1:219 HEATHERSTONE RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1692
Practice Address - Country:US
Practice Address - Phone:413-695-6069
Practice Address - Fax:423-665-9871
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist