Provider Demographics
NPI:1689944118
Name:DONALD, ELLEN KROOG (PT)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:KROOG
Last Name:DONALD
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 1:16610 WILLOW POINT CT
Mailing Address - Street 2:
Mailing Address - City:ALVA
Mailing Address - State:FL
Mailing Address - Zip Code:33920-3162
Mailing Address - Country:US
Mailing Address - Phone:239-850-7183
Mailing Address - Fax:
Practice Address - Street 1:14391 METROPOLIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4423
Practice Address - Country:US
Practice Address - Phone:239-561-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist