Provider Demographics
NPI:1255535340
Name:KING, ELLEN (PT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KING
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:PO BOX 5571
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0571
Mailing Address - Country:US
Mailing Address - Phone:541-505-8180
Mailing Address - Fax:541-505-7134
Practice Address - Street 1:1180 PATTERSON ST STE 3-A
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3619
Practice Address - Country:US
Practice Address - Phone:541-505-8180
Practice Address - Fax:541-505-7134
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-036762251X0800X
MO20040307902251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS37718011OtherBCBSKC