Provider Demographics
NPI:1801531199
Name:MEISNER, ELLEN (DPT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:MEISNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W MARQUITA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-5157
Mailing Address - Country:US
Mailing Address - Phone:715-977-2120
Mailing Address - Fax:
Practice Address - Street 1:4747 MISSION BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2541
Practice Address - Country:US
Practice Address - Phone:858-247-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist