Provider Demographics
NPI:1659443703
Name:ELLENBECKER, TODD SIDNEY (DPT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:SIDNEY
Last Name:ELLENBECKER
Suffix:
Gender:M
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:PO BOX 18607
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-8607
Mailing Address - Country:US
Mailing Address - Phone:480-419-3500
Mailing Address - Fax:480-419-3522
Practice Address - Street 1:10121 E BELL ROAD
Practice Address - Street 2:SUITE 140
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2187
Practice Address - Country:US
Practice Address - Phone:480-419-3500
Practice Address - Fax:480-419-3522
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1376174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist