| Doctor Name: | SHASTA J ELLENBURG |
| NPI Number: | 1104113935 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | PTH4042 |
| Business Practice Address: | 1254 Andrews Ave Ozark, AL - 363603712 |
| Business Phone Number: | 3344451380 |
| Business Fax Number: | 3344451489 |
| Mailing Address: | Po Box 949, ROME |
| State: | GA |
| Postal Code: | 301620949 |
| Phone Number: | 7062362774 |
| Fax Number: | 7068021408 |
| NPI Enumeration Date: | 06/30/2011 |
| NPI Last Update Date: | 06/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PTH4042 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |