Provider Demographics
NPI:1750422846
Name:ACKROYD, ELLEN M (PT)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:ACKROYD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:ELLEN
Other - Middle Name:M
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:15906 MILL CREEK BLVD
Practice Address - Street 2:106
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1797
Practice Address - Country:US
Practice Address - Phone:425-332-1030
Practice Address - Fax:425-332-1035
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00010162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464489Medicaid
WA8865471Medicare ID - Type UnspecifiedMEDICARE NUMBER