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
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