Provider Demographics
NPI:1700147626
Name:ELLENBERGER, ANNA (DPT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:ELLENBERGER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:324 RODI RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-3318
Mailing Address - Country:US
Mailing Address - Phone:412-242-7880
Mailing Address - Fax:412-242-6040
Practice Address - Street 1:4262 OLD WILLIAM PENN HWY
Practice Address - Street 2:PROFESSIONAL COMMONS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15668-1953
Practice Address - Country:US
Practice Address - Phone:724-387-1000
Practice Address - Fax:724-387-1011
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38902225100000X
PAPT026891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB249475Medicare PIN