Provider Demographics
NPI:1881819506
Name:STURGEON, ELLEN MARGUET (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARGUET
Last Name:STURGEON
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 OLD VINCENNES RD
Mailing Address - Street 2:BOX 67
Mailing Address - City:GREENVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47124-9511
Mailing Address - Country:US
Mailing Address - Phone:812-923-7554
Mailing Address - Fax:
Practice Address - Street 1:8536 OLD VINCENNES RD
Practice Address - Street 2:BOX 67
Practice Address - City:GREENVILLE
Practice Address - State:IN
Practice Address - Zip Code:47124-9511
Practice Address - Country:US
Practice Address - Phone:812-923-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000757A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist