Provider Demographics
NPI:1750940276
Name:ELLINGER, TORI (PTA)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:ELLINGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:TORI
Other - Middle Name:
Other - Last Name:BIRKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 E 300 S
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7837
Mailing Address - Country:US
Mailing Address - Phone:219-246-7710
Mailing Address - Fax:
Practice Address - Street 1:17495 DUGDALE DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1545
Practice Address - Country:US
Practice Address - Phone:574-247-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-08
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005904A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant