Individual provider Active NPI

Brittany N Ellis, DPT

  • Physical Therapist
  • Johnson City, TN
National Provider Identifier
1508488115
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12713 Issued in TN
Practice address
2410 Susannah St
Johnson City, TN 37601-1748
Phone
(423) 282-9011
Fax
(423) 282-0035
NPI assigned
May 18, 2020
Last updated
May 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12713 TN Primary

Addresses

Primary practice location

2410 Susannah St
Johnson City, TN 37601-1748

Mailing address

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011

Other practice location 1

340 Steeles Rd
Bristol, TN 37620-9532
Phone (423) 282-9011

Other practice location 2

875 Larry Neil Way
Kingsport, TN 37660-6368
Phone (423) 282-9011

Other names 1

  • Miss Brittany N Gray Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200526002026 TN Practitioner - Physical Therapist in Private Practice 9436570652 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Watauga Orthopaedics PLCGroup PAC ID 1456246479, 85 clinicians

Practice addresses (Care Compare)

2410 Susannah St
Johnson City, TN 37601-1748
Phone (423) 282-9011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12713TNMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Watauga Orthopaedics PLC Physical Therapist CurrentSince Dec 6, 2021 Accepting new patients
Watauga Orthopaedics, PLC Physical Therapist CurrentSince Dec 6, 2021 Accepting new patients
Watauga Orthopaedics, PLC Physical Therapist Past Accepting new patients
PT Solutions LLC Physical Therapist PastSince Feb 16, 2020 Accepting new patients

Locations

340 Steeles Rd
Bristol, TN 37620
Phone (423) 282-9011

2410 Susannah St
Johnson City, TN 37601
Phone (423) 282-9011

2412 Susannah St
Johnson City, TN 37601
Phone (423) 282-8070

875 Larry Neil Way
Kingsport, TN 37660
Phone (423) 282-9011

Interoperability endpoints

  • Direct secure messaging: brittany.gray.1@3374.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/3374/brand/1/csg/1/fhir/r4

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1508488115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011",
            "fax_number": "123-282-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 SUSANNAH ST",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376011748",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "340 Steeles Rd",
            "address_purpose": "LOCATION",
            "city": "Bristol",
            "state": "TN",
            "postal_code": "376209532",
            "country_code": "US",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "875 Larry Neil Way",
            "address_purpose": "LOCATION",
            "city": "Kingsport",
            "state": "TN",
            "postal_code": "376606368",
            "country_code": "US",
            "telephone_number": "423-282-9011",
            "fax_number": "423-282-0035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BRITTANY",
        "middle_name": "N",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-18",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "12713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRITTANY",
            "last_name": "GRAY",
            "middle_name": "N",
            "prefix": "MISS",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.