Active NPI
Ellen Deanne Wallace, PT
- Physical Therapist
- Winchester, KY
National Provider Identifier
1871756957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 003834
- Practice address
- 404 Cedar CT
Winchester, KY 40391-2923 - Phone
- (859) 737-5888
- NPI assigned
- Jul 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 | 003834 | KY | Primary |
Addresses
Primary practice location
404 Cedar CT
Winchester, KY 40391-2923
Mailing address
404 Cedar CT
Winchester, KY 40391-2923
Phone (859) 737-5888
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 |
|---|---|---|---|
| 003834 | KY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215475200000",
"number": "1871756957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 CEDAR CT",
"city": "WINCHESTER",
"state": "KY",
"postal_code": "403912923",
"telephone_number": "859-737-5888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 CEDAR CT",
"city": "WINCHESTER",
"state": "KY",
"postal_code": "403912923",
"telephone_number": "859-737-5888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ELLEN",
"middle_name": "DEANNE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-08",
"last_updated": "2008-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KY",
"license": "003834",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winchester, KY
- Wal-Mart Stores East, LP (Vision Center 30-0702)
- Abigail Walcott, OTD/R
- Walgreen Co (Walgreens #10889)
- Walgreen Co (Walgreens #17138)
- Angela Wallace, RN, SANE
- Walter N. Peavler, DMD, PLLC (Central KY Dental)
- John Paul Warber, R.D.
- Hannah E Wasson, APRN
- Michelle L Watkins, APRN, FNP-C
- Jacob Webster, OD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.