Provider Demographics
NPI:1801184049
Name:MCELHENNY, COLLEEN (PT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:MCELHENNY
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 1:12940 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-3260
Mailing Address - Country:US
Mailing Address - Phone:907-336-2114
Mailing Address - Fax:
Practice Address - Street 1:12940 HILLSIDE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-3260
Practice Address - Country:US
Practice Address - Phone:907-336-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist