Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PA |
NPI | 1477163368 |
---|---|
Provider Name | Ryan Ellis |
First Address | Centre Hall, PA 16828-9150 |
Second Address | Mifflin, PA 17058-7030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2020 |
Last Update Date | 05/08/2020 |