Provider Demographics
NPI:1790005643
Name:ELLMAN, CRYSTAL M (PT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:ELLMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:830 S ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2877
Mailing Address - Country:US
Mailing Address - Phone:630-620-4433
Mailing Address - Fax:630-620-1148
Practice Address - Street 1:1323 BOND ST
Practice Address - Street 2:SUITE 119
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2367
Practice Address - Country:US
Practice Address - Phone:630-357-9699
Practice Address - Fax:630-357-9908
Is Sole Proprietor?:No
Enumeration Date:2010-06-02
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.005544OtherPT LICENSE