Provider Demographics
NPI:1821596958
Name:MELROSE, ELLISON RACHEL (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELLISON
Middle Name:RACHEL
Last Name:MELROSE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ELLISON
Other - Middle Name:RACHEL
Other - Last Name:MCMILLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2821 LOU ANN DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6557 BUTTERCUP DR UNIT 6
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80549-2396
Practice Address - Country:US
Practice Address - Phone:307-222-2337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294317225100000X
CO0016197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist