Provider Demographics
NPI:1962131052
Name:ELLIS-TIBBETTS, ERICA (DPT)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:ELLIS-TIBBETTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:612 E LAYTON DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2819
Mailing Address - Country:US
Mailing Address - Phone:913-787-1785
Mailing Address - Fax:
Practice Address - Street 1:818 ANN AVENUE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101
Practice Address - Country:US
Practice Address - Phone:913-562-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06417225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist