Provider Demographics
NPI:1679542385
Name:ELLIS, DEBRA A (PT,CHT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:A
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2344
Mailing Address - Country:US
Mailing Address - Phone:602-843-8436
Mailing Address - Fax:
Practice Address - Street 1:1060 PLAZA DR
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2344
Practice Address - Country:US
Practice Address - Phone:602-843-8436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL0003847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist