Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT.015368 | OH |
NPI | 1003295858 |
---|---|
Provider Name | Matthew T. Ely |
First Address | Hinckley, OH 44233-9561 |
Second Address | Hinckley, OH 44233-9561 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2015 |
Last Update Date | 13/11/2015 |