Provider Demographics
NPI:1063898625
Name:AMES, ELEANOR (PT, DPT, MTC, CLT)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:
Last Name:AMES
Suffix:
Gender:F
Credentials:PT, DPT, MTC, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13203 OVERCUP OAK CT APT 302
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4888
Mailing Address - Country:US
Mailing Address - Phone:860-942-9978
Mailing Address - Fax:
Practice Address - Street 1:13203 OVERCUP OAK CT APT 302
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4888
Practice Address - Country:US
Practice Address - Phone:860-942-9978
Practice Address - Fax:571-388-3161
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212626225100000X
CT12046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist