Provider Demographics
NPI:1023258860
Name:ALDERMAN, ELLEN M
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:ALDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11730 SW 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-4071
Mailing Address - Country:US
Mailing Address - Phone:305-942-4402
Mailing Address - Fax:305-442-8730
Practice Address - Street 1:2645 SW 37TH AVE
Practice Address - Street 2:304
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2754
Practice Address - Country:US
Practice Address - Phone:786-924-4502
Practice Address - Fax:305-442-8730
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT3443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001443500Medicaid