Provider Demographics
NPI:1891291910
Name:HORNBEAK, ELLEN SUMNER (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:SUMNER
Last Name:HORNBEAK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4712 NE 13TH CT
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-6309
Mailing Address - Country:US
Mailing Address - Phone:281-620-7869
Mailing Address - Fax:
Practice Address - Street 1:200 TRIANGLE SHOPPING CTR STE 270
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-501-3750
Practice Address - Fax:360-501-3755
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62610225100000X
WAPT60903963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist