Provider Demographics
NPI:1245019678
Name:TYLER, ELLEN MARIE (PT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARIE
Last Name:TYLER
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 1:70 BATES RD
Mailing Address - Street 2:
Mailing Address - City:ABBOT
Mailing Address - State:ME
Mailing Address - Zip Code:04406-3402
Mailing Address - Country:US
Mailing Address - Phone:860-227-1361
Mailing Address - Fax:
Practice Address - Street 1:70 BATES RD
Practice Address - Street 2:
Practice Address - City:ABBOT
Practice Address - State:ME
Practice Address - Zip Code:04406-3402
Practice Address - Country:US
Practice Address - Phone:860-227-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14.002421225100000X
MEPT4431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist