Provider Demographics
NPI:1427268945
Name:AMERICUS, ELLEN (PT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:AMERICUS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241889
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1889
Mailing Address - Country:US
Mailing Address - Phone:907-563-1777
Mailing Address - Fax:907-561-7464
Practice Address - Street 1:4 1 WHITSHED RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AK
Practice Address - Zip Code:99574-3942
Practice Address - Country:US
Practice Address - Phone:907-424-3942
Practice Address - Fax:907-424-3424
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT05541Medicaid
AKK160613Medicare ID - Type Unspecified