Active NPI
Meredith Ellerbe, PTA
- Physical Therapy Assistant
- El Dorado, AR
National Provider Identifier
1952608259
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA 2044
- Practice address
- 714 W Grove St
El Dorado, AR 71730-4416 - Phone
- (870) 863-8194
- Fax
- (870) 881-4619
- NPI assigned
- Feb 22, 2011
- 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 Therapy Assistant | 225200000X | PTA 2044 | AR | Primary |
Addresses
Primary practice location
714 W Grove St
El Dorado, AR 71730-4416
Mailing address
714 W Grove St
El Dorado, AR 71730-4416
Phone (870) 863-8194
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 158606721 | Medicaid | AR |
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 |
|---|---|---|---|
| PTA 2044 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1298332800000",
"number": "1952608259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 W GROVE ST",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717304416",
"telephone_number": "870-863-8194",
"fax_number": "870-881-4619"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 W GROVE ST",
"city": "EL DORADO",
"state": "AR",
"postal_code": "717304416",
"telephone_number": "870-863-8194",
"fax_number": "870-881-4619"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLERBE",
"first_name": "MEREDITH",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-02-22",
"last_updated": "2011-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "AR",
"license": "PTA 2044",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "158606721",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Dorado, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.