Provider Demographics
NPI:1669974242
Name:MORICONE, ELLEN V (PTA)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:V
Last Name:MORICONE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:VITOULIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:612 WILLINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7479
Mailing Address - Country:US
Mailing Address - Phone:919-924-1861
Mailing Address - Fax:
Practice Address - Street 1:1206 W CHATHAM ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-5246
Practice Address - Country:US
Practice Address - Phone:919-462-9147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA3384225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant