Provider Demographics
NPI:1720202088
Name:ERNST, MARYELLEN (PT, CP)
Entity Type:Individual
Prefix:MISS
First Name:MARYELLEN
Middle Name:
Last Name:ERNST
Suffix:
Gender:F
Credentials:PT, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100B ROCKING HORSE ROAD
Mailing Address - Street 2:SOUTHSHORE
Mailing Address - City:CHRISTCHURCH
Mailing Address - State:NEW ZEALAND
Mailing Address - Zip Code:8062
Mailing Address - Country:NZ
Mailing Address - Phone:643-382-5556
Mailing Address - Fax:
Practice Address - Street 1:28 NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1805
Practice Address - Country:US
Practice Address - Phone:781-598-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA82162251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports