Provider Demographics
NPI:1558801563
Name:SHIELDS, ELLINA (DPT)
Entity Type:Individual
Prefix:
First Name:ELLINA
Middle Name:
Last Name:SHIELDS
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 1:2928 ROYAL CREST CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7263
Mailing Address - Country:US
Mailing Address - Phone:614-260-7445
Mailing Address - Fax:
Practice Address - Street 1:2655 COMMONS BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3773
Practice Address - Country:US
Practice Address - Phone:937-320-9131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016739225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist