Active NPI
Mallie Ellison
- Physical Therapist
- Attalla, AL
National Provider Identifier
1679602197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PTH1575
- Practice address
- 425 5TH Ave NW
Attalla, AL 35954-2214 - Phone
- (256) 538-2273
- Fax
- (256) 538-9373
- NPI assigned
- Mar 2, 2007
- Sex
- Female
- 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 Therapist | 225100000X | PTH1575 | AL | Primary |
Addresses
Primary practice location
425 5TH Ave NW
Attalla, AL 35954-2214
Mailing address
1007 Goodyear Ave
Gadsden, AL 35903-1195
Phone (256) 538-2273
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 |
|---|---|---|---|
| PTH1575 | AL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679602197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1007 GOODYEAR AVE",
"city": "GADSDEN",
"state": "AL",
"postal_code": "359031195",
"telephone_number": "256-538-2273",
"fax_number": "256-538-9373"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 5TH AVE NW",
"city": "ATTALLA",
"state": "AL",
"postal_code": "359542214",
"telephone_number": "256-538-2273",
"fax_number": "256-538-9373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "MALLIE",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AL",
"license": "PTH1575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Attalla, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.