Jack W Ellertson, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTO16235 Issued in PA

Practice address

1035 Wayne Ave
Chambersburg, PA 17201-2986

Phone

(717) 264-6211

Fax

(717) 264-9816

NPI assigned

Jun 21, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341792000000",
    "number": "1669418489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 WAYNE AVE",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172012986",
            "telephone_number": "717-264-6211",
            "fax_number": "717-264-9816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 WAYNE AVE",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172012986",
            "telephone_number": "717-264-6211",
            "fax_number": "717-264-9816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLERTSON",
        "first_name": "JACK",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2012-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PTO16235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ELI1783757",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLUE SHIELD",
            "identifier": "ELI1783757",
            "state": "PW"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CROSS",
            "identifier": "50056652",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Chambersburg, PA
• Providers in Chambersburg, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; 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.