Individual
SHASTA J ELLENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1254 ANDREWS AVE, OZARK, AL 36360-3712
(334) 445-1380
(334) 445-1489
Mailing address
PO BOX 949, ROME, GA 30162-0949
(706) 236-2774
(706) 802-1408
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH4042
AL
Other
Enumeration date
06/30/2011
Last updated
06/30/2011
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