Ted Ellquist, Pt

NPI 1053422485 - Clinic/Center - 261QP2000X

NPI Details
NPI 1053422485
Enumeration Date 08/31/2006
Last Updated 09/20/2010
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name TED IAN TED
Position STAFF PT
Phone (503) 358-8278
Fax
Practice Location
2466 MURDOCK DR
SANTA ROSA CA, 95404-2207, US
Phone (503) 358-8278
Fax
Business Location
2466 MURDOCK DR
SANTA ROSA CA, 95404-2207, US
Phone (503) 358-8278
Fax
Toxanomy
Taxonomy Code 261QP2000X
License State California
License Number 36493
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According to our database, Ted Ellquist, Pt NPI is 1053422485, taxonomy code is 261QP2000X and license number is 36493, license state is located at California. Ted Ellquist, Pt physically located at 2466 Murdock Dr, Santa Rosa CA, 95404-2207. NPI Number 1033115704 has the healthcare provider type.

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1053422485 NPI number is provided on an as is basis without warranty of any kind. 1053422485 is maintained by the National Plan & Provider Enumeration System. The contents of Ted Ellquist, Pt are for informational purposes only.