Individual
MR. BRIAN JON ELLINGWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1431 PREMIER DR, MANKATO, MN 56001-6076
(507) 386-6700
(507) 388-8372
Mailing address
1431 PREMIER DR, MANKATO, MN 56001-6076
(507) 386-6600
(507) 625-5971
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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