Provider Demographics
NPI:1740420058
Name:MAGGS, ELLORA (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:ELLORA
Middle Name:
Last Name:MAGGS
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:ELLORA
Other - Middle Name:
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4143
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-4143
Mailing Address - Country:US
Mailing Address - Phone:209-532-1288
Mailing Address - Fax:209-230-9529
Practice Address - Street 1:13949 MONO WAY
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-2807
Practice Address - Country:US
Practice Address - Phone:209-533-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305211605225100000X
CA353122251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty