Provider Demographics
NPI:1699814798
Name:FRIEDMAN, ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FRIEDMAN
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 1:2361 E CHERYL DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3613
Mailing Address - Country:US
Mailing Address - Phone:602-809-9948
Mailing Address - Fax:602-788-9895
Practice Address - Street 1:10213 N 92ND ST STE 102
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4561
Practice Address - Country:US
Practice Address - Phone:480-699-4867
Practice Address - Fax:480-699-4894
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102022Medicare ID - Type Unspecified