Organization
TED ELLQUIST, PT
Active
Organization
TED ELLQUIST, PT
Active
Other names
Ted Ellquist, PT
Organization subpart
No
Provider details
NPI number
Authorized official
TED IAN ELLQUIST P.T. (STAFF PT)
(503) 358-8278
Entity
Organization
Contact information
Practice address
2466 MURDOCK DR, SANTA ROSA, CA 95404-2207
(503) 358-8278
Mailing address
2466 MURDOCK DR, SANTA ROSA, CA 95404-2207
(503) 358-8278
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
36493
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770516734
PERSONAL NPI
CA
01
—
36493
CALIFORNIA LICENSE
CA
Enumeration date
08/31/2006
Last updated
09/20/2010
Update your record
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