Active NPI
Crystal M Ellman, PT
- Physical Therapist
- Naperville, IL
National Provider Identifier
1790005643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 1323 Bond St
Suite 119
Naperville, IL 60563-2367 - Phone
- (630) 357-9699
- Fax
- (630) 357-9908
- NPI assigned
- Jun 2, 2010
- 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 | Primary |
Addresses
Primary practice location
1323 Bond St
Suite 119
Naperville, IL 60563-2367
Mailing address
830 S Addison Ave
Villa Park, IL 60181-2877
Phone (630) 620-4433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070.005544 | Other | IL | PT LICENSE |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Easter Seals Dupage and the Fox Valley Region | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Villa Park, IL
- NPI 1568460681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276560000000",
"number": "1790005643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 S ADDISON AVE",
"city": "VILLA PARK",
"state": "IL",
"postal_code": "601812877",
"telephone_number": "630-620-4433",
"fax_number": "630-620-1148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1323 BOND ST",
"address_2": "SUITE 119",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605632367",
"telephone_number": "630-357-9699",
"fax_number": "630-357-9908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLMAN",
"first_name": "CRYSTAL",
"middle_name": "M",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-06-02",
"last_updated": "2010-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE",
"identifier": "070.005544",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.