Active NPI
Cory Ellis, PTA
- Physical Therapy Assistant
- Brewer, ME
National Provider Identifier
1538452255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PA3258
- Practice address
- 248 State Street
Brewer, ME 04412 - Phone
- (207) 989-2034
- Fax
- (207) 989-5971
- NPI assigned
- May 27, 2011
- Last updated
- May 27, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PA3258 | ME | Primary |
Addresses
Primary practice location
248 State Street
Brewer, ME 04412
Mailing address
248 State St
Brewer, ME 04412-1519
Phone (207) 989-2034
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA3258 | ME | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306454400000",
"number": "1538452255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 STATE ST",
"city": "BREWER",
"state": "ME",
"postal_code": "044121519",
"telephone_number": "207-989-2034",
"fax_number": "207-989-5971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "248 STATE STREET",
"city": "BREWER",
"state": "ME",
"postal_code": "04412",
"telephone_number": "207-989-2034",
"fax_number": "207-989-5971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "CORY",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-27",
"last_updated": "2011-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ME",
"license": "PA3258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brewer, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.