Provider Demographics
NPI:1508385915
Name:ELLINGTON, PAUL DAVID JR (DPT)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:ELLINGTON
Suffix:JR
Gender:M
Credentials:DPT
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Mailing Address - Street 1:11800 SUNRISE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5300
Practice Address - Country:US
Practice Address - Phone:703-709-1116
Practice Address - Fax:703-709-5134
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305211470225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508385915Medicaid
VA30017527950001Medicaid