Provider Demographics
NPI:1669792081
Name:SPILLER, ELLEN ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:ELIZABETH
Last Name:SPILLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7467 ST ANDREWS ROAD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2876
Mailing Address - Country:US
Mailing Address - Phone:803-749-5031
Mailing Address - Fax:803-749-5032
Practice Address - Street 1:7467 ST ANDREWS ROAD
Practice Address - Street 2:SUITE 9
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2876
Practice Address - Country:US
Practice Address - Phone:803-749-5031
Practice Address - Fax:803-749-5032
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7620225100000X
TX31088662251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics