Active NPI
Denise Michele Ellis, P.T.
- Physical Therapist
- St. Louis, MO
National Provider Identifier
1881808335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 104430
- Practice address
- 739 Woodward Dr
St. Louis, MO 63125-5128 - Phone
- (314) 892-2108
- Fax
- (314) 432-7426
- NPI assigned
- May 10, 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 | 104430 | MO | Primary |
Addresses
Primary practice location
739 Woodward Dr
St. Louis, MO 63125-5128
Mailing address
739 Woodward Dr
Saint Louis, MO 63125-5128
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 |
|---|---|---|---|
| 104430 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1881808335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "739 WOODWARD DR",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631255128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "739 WOODWARD DR",
"city": "ST. LOUIS",
"state": "MO",
"postal_code": "631255128",
"telephone_number": "314-892-2108",
"fax_number": "314-432-7426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "DENISE",
"middle_name": "MICHELE",
"name_prefix": "Ms.",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "104430",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St. Louis, MO
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.