Provider Demographics
NPI:1063592426
Name:TOMSIC, ELLEN M (PT, OCS, FAAOMPT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:TOMSIC
Suffix:
Gender:F
Credentials:PT, OCS, FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 RIVERGATE LN.
Mailing Address - Street 2:SUITE #97
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7490
Mailing Address - Country:US
Mailing Address - Phone:970-259-0574
Mailing Address - Fax:970-259-0576
Practice Address - Street 1:575 RIVERGATE LN
Practice Address - Street 2:SUITE #97
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7490
Practice Address - Country:US
Practice Address - Phone:970-259-0574
Practice Address - Fax:970-259-0576
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81627271Medicaid
CO1063592426Medicare PIN