Israel Ellerbrock, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

P160835239 Issued in WA

Practice address

615 Lilly Rd NE Ste 240
Olympia, WA 98506-5117

Phone

(360) 413-3850

NPI assigned

Aug 24, 2024

Last updated

Aug 24, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1724457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724457600000",
    "number": "1558194423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2314 COOPER CREST ST NW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985024032",
            "telephone_number": "831-207-0828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 LILLY RD NE STE 240",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065117",
            "telephone_number": "360-413-3850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERBROCK",
        "first_name": "ISRAEL",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-24",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WA",
            "license": "P160835239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nichole E Eliason, NUTRITIONAL THERAPY
• Wendy Eliason, SLP
• David R Elkins, PA
• Lauren Elle, LMP
• Jon Benjamin Eller
• Robin Grace Ellingson-Miller, ARNP
• Angela Elliott, CP61279999
• Laura K Elliott, LMP
• Olivia Traver Ellis-Jenko, OTR/L
• Amber Ellis, L.M.P

• Physical Therapy Assistant in Olympia, WA
• Providers in Olympia, WA by specialty
• Physical Therapy Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.