Provider Demographics
NPI:1821550997
Name:ADAMS, ELLEN NARCISSE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:NARCISSE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:ANTOINETTE
Other - Last Name:NARCISSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14300 GALLANT FOX LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715
Mailing Address - Country:US
Mailing Address - Phone:301-785-6980
Mailing Address - Fax:
Practice Address - Street 1:14300 GALLANT FOX LANE
Practice Address - Street 2:SUITE 104
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715
Practice Address - Country:US
Practice Address - Phone:301-785-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14540225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist