Provider Demographics
NPI:1942548300
Name:ELLETT, HELEN (PT)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:ELLETT
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 1:6102 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1671
Mailing Address - Country:US
Mailing Address - Phone:361-894-5571
Mailing Address - Fax:
Practice Address - Street 1:6102 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1671
Practice Address - Country:US
Practice Address - Phone:361-894-5571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-19
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1121986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist