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General NPI Number Information
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NPI Number | 1295811347
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Entity Type | Individual
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Provider Name | KRIS J ELLINGTON PT
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Gender | Female
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3200 BIDDLE ST 3RD FL
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City | WYANDOTTE
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State | MI
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Zip | 48192-5937
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Country | US
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Telephone | 734-324-3946
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Fax |
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Provider Business Mailing Address
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Address Line | 13947 PERRY
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City | RIVERVIEW
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State | MI
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Zip | 48193-4568
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Country | US
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Telephone | 734-284-5994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501004107
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License Number State | MI
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