Active NPI
Jenny Ellison
- Physical Therapist
- Yakima, WA
National Provider Identifier
1750815494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT5764
- Practice address
- 2415 Summitview Ave
Yakima, WA 98902-2347 - Phone
- (850) 377-3196
- NPI assigned
- Apr 19, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physical Therapist | 225100000X | PT5764 | NM | Primary |
Addresses
Primary practice location
2415 Summitview Ave
Yakima, WA 98902-2347
Mailing address
8820 Desert Fox Way NE
Albuquerque, NM 87122-3647
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 |
|---|---|---|---|
| PT5764 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1492560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630972800000",
"number": "1750815494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8820 DESERT FOX WAY NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871223647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2415 SUMMITVIEW AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989022347",
"telephone_number": "850-377-3196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLISON",
"first_name": "JENNY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-04-19",
"last_updated": "2021-09-07",
"certification_date": "2021-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "PT5764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.