Jennie Ellis Haithcock, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5762 Issued in SC

Practice address

205 Midland Pkwy
Summerville, SC 29485-8122

Phone

(843) 875-7163

Fax

(843) 875-7169

NPI assigned

May 10, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennie Elizabeth Ellis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1273449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273449600000",
    "number": "1891013389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 SULLIVAN TRL",
            "city": "EASTON",
            "state": "PA",
            "postal_code": "180407958",
            "telephone_number": "800-944-9782",
            "fax_number": "610-438-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 MIDLAND PKWY",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294858122",
            "telephone_number": "843-875-7163",
            "fax_number": "843-875-7169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAITHCOCK",
        "first_name": "JENNIE",
        "middle_name": "ELLIS",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-10",
        "last_updated": "2010-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIE",
            "last_name": "ELLIS",
            "middle_name": "ELIZABETH",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Veronica Guy, DMD
• Jenni Lisa Hackenberg
• Rebecca D Hackett, LPC
• Claudia M Hafer
• Deborah Elizabeth Haffner, DMD
• Tayo E Haiyede, DMSC, PA-C.
• Paul William Halczenko, MD
• Jenny Lore Haley, MD
• Courtney K Hall, CRNA
• Crystal Hall

• Physical Therapist in Summerville, SC
• Providers in Summerville, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 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.

Verify at the official NPI Registry.