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Individual
MR. BRIAN JON ELLINGWORTH
Active
Individual
MR. BRIAN JON ELLINGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3052
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103183C572
UCARE MN
MN
01
—
11F45EL
BCBS OF MN
MN
01
—
6404857
MEDICA, MANKATO
MN
01
—
6404967
MEDICA, WATERVILLE
MN
01
—
983181027668
PREFERRED ONE
MN
01
—
H035
TRICARE
MN
01
—
HP43586
HEALTH PARTNERS
MN
Enumeration date
05/03/2006
Last updated
07/22/2011
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