SHASTA J ELLENBURG

OZARK, AL
NPI1104113935
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: AL  PTH4042)
Enumeration Date2011-06-30
Last Update Date2011-06-30
Business Address
-- SHASTA J ELLENBURG PT
1254 ANDREWS AVE
OZARK, AL 36360-3712
Phone number: 334-445-1380
Mailing Address
-- SHASTA J ELLENBURG PT
PO BOX 949
ROME, GA 30162-0949
Phone number: 706-236-2774
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