Provider Demographics
NPI:1174595789
Name:ENNIS, ELIZABETH C (PT, PCS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C
Last Name:ENNIS
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Gender:F
Credentials:PT, PCS
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Mailing Address - Street 1:7410 NEW LAGRANGE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4871
Mailing Address - Country:US
Mailing Address - Phone:502-429-0876
Mailing Address - Fax:502-891-2613
Practice Address - Street 1:7410 NEW LAGRANGE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4871
Practice Address - Country:US
Practice Address - Phone:502-429-0876
Practice Address - Fax:502-891-2613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY34552251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics