Provider Demographics
NPI:1639116965
Name:ELLISON, NATALIE DAWN (DPT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:DAWN
Last Name:ELLISON
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 1:266 ORLANDO DR
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-6313
Mailing Address - Country:US
Mailing Address - Phone:214-457-0057
Mailing Address - Fax:
Practice Address - Street 1:266 ORLANDO DR
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577-6313
Practice Address - Country:US
Practice Address - Phone:214-457-0057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4895Medicare ID - Type UnspecifiedGROUP NUMBER
GA65BBDNKMedicare PIN