Jacob Ryan Ellingson
Physical Therapist - Sports
301 Highway 65 S
Mora
, Minnesota 55051-1899
Jacob Ryan Ellingson
Physical Therapist - Sports
301 Highway 65 S
Mora
, Minnesota 55051-1899
(320) 225-3370
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About
Features
Specialties
- Physical Therapist - Sports
Languages spoken
- English
Location
First Address
- Jacob Ryan Ellingson
- 301 Highway 65 S
- Mora, MN
- Zip : 55051-1899
- Fax : (320) 225-3370
- Phone : (320) 225-3356
Second Address
- Jacob Ryan Ellingson
- 301 Highway 65 S
- Mora, MN
- Zip : 55051-1899
- Fax : (320) 225-3370
- Phone : (320) 225-3356
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2251S0007X | Physical Therapist - Sports | 6749 | MN |
National Provider Identifier
| NPI | 1346210432 |
|---|---|
| Provider Name | Jacob Ryan Ellingson |
| First Address | Mora, MN 55051-1899 |
| Second Address | Mora, MN 55051-1899 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 23/01/2006 |
| Last Update Date | 09/07/2014 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.