Provider Demographics
NPI:1194956235
Name:ELLSWORTH, LINDSEY ERIN (PTA)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:ERIN
Last Name:ELLSWORTH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N 20TH ST
Mailing Address - Street 2:BUILDING 18
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5449
Mailing Address - Country:US
Mailing Address - Phone:334-364-2249
Mailing Address - Fax:334-364-2251
Practice Address - Street 1:121 N 20TH ST
Practice Address - Street 2:BUILDING 18
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5449
Practice Address - Country:US
Practice Address - Phone:334-364-2249
Practice Address - Fax:334-364-2251
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2 0549225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant