Provider Demographics
NPI:1336214808
Name:ELLWORTH, MARTHA LOUISE (PT, MA)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LOUISE
Last Name:ELLWORTH
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Gender:F
Credentials:PT, MA
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Mailing Address - Street 1:2300 N CHILDRENS PLZ
Mailing Address - Street 2:REHAB DIVISION # 158
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3363
Mailing Address - Country:US
Mailing Address - Phone:773-880-4742
Mailing Address - Fax:773-880-3904
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:REHAB DIVISION # 158
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4742
Practice Address - Fax:773-880-3904
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL70002026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist