MEDICARE: AMY LOUISE ELLIS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT3183	FL

General Provider Information

NPI Number	:	1548272081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LOUISE ELLIS PT

Provider Business Mailing Address
First Line	:	5100 S CLYDE MORRIS BLVD
Second Line	:	SUITE 200
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-8976
Country	:	US
Telephone Number	:	386-304-8112
Fax Number	:	386-304-8014

Provider Business Practice Location Address
First Line	:	5100 S CLYDE MORRIS BLVD
Second Line	:	SUITE 200
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-8976
Country	:	US
Telephone Number	:	386-304-8112
Fax Number	:	386-304-8014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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Directions to “ AMY LOUISE ELLIS PT” Practice Location

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