Provider Demographics
NPI:1790099364
Name:ELLIS, SCOTT L (PT, DPT)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:L
Last Name:ELLIS
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 7132960
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-0001
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:7409 WOODRIDGE DR STE F
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2249
Practice Address - Country:US
Practice Address - Phone:630-967-2000
Practice Address - Fax:630-545-3536
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8978225100000X
IL070-027208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist