Provider Demographics
NPI:1205300936
Name:ROWE, ELLE M (PTA)
Entity type:Individual
Prefix:
First Name:ELLE
Middle Name:M
Last Name:ROWE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BAHR RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:PA
Mailing Address - Zip Code:18833-8805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5865 ROUTE 154
Practice Address - Street 2:
Practice Address - City:FORKSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18616-8912
Practice Address - Country:US
Practice Address - Phone:607-857-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI005308225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant