Provider Demographics
NPI:1972059475
Name:GIROUARD, ELLEN (DPT, PT)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GIROUARD
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AUTUMN RD
Mailing Address - Street 2:
Mailing Address - City:WRENTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02093-1845
Mailing Address - Country:US
Mailing Address - Phone:508-954-7127
Mailing Address - Fax:
Practice Address - Street 1:85 BEACH ST
Practice Address - Street 2:BLDG. D
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2717
Practice Address - Country:US
Practice Address - Phone:401-348-8112
Practice Address - Fax:401-348-7009
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI02940225100000X
MA22525225100000X
CT11136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist