Provider Demographics
NPI:1639147515
Name:FLEYSHMAN, ELLA (PT)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:FLEYSHMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2781 BUTTERCUP CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-5455
Mailing Address - Country:US
Mailing Address - Phone:215-953-9944
Mailing Address - Fax:215-953-9943
Practice Address - Street 1:2 PARK LANE PROFESSIONAL BUILDING
Practice Address - Street 2:SUITE 104
Practice Address - City:FEASTERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19053-6004
Practice Address - Country:US
Practice Address - Phone:215-953-9944
Practice Address - Fax:215-953-9943
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP65828Medicare UPIN