Provider Demographics
NPI:1174931760
Name:STOCKHAUSEN, ELLEN MAGEE (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:MAGEE
Last Name:STOCKHAUSEN
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 RIVERGATE LN STE B1-108
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7473
Mailing Address - Country:US
Mailing Address - Phone:970-422-8575
Mailing Address - Fax:970-900-6654
Practice Address - Street 1:555 RIVERGATE LN STE B1-108
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7473
Practice Address - Country:US
Practice Address - Phone:970-422-8575
Practice Address - Fax:970-900-6654
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00120162251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic