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General NPI Number Information
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NPI Number | 1396275301
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Entity Type | Individual
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Provider Name | SANDRA ELLIS DPT
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Gender | Female
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Dates
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Enumeration Date | 06/13/2017
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 642 W LANCASHIRE BLVD
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City | BELLA VISTA
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State | AR
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Zip | 72715-3027
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Country | US
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Telephone | 479-876-6686
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Fax |
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Provider Business Mailing Address
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Address Line | 4 DULVERTON DR
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City | BELLA VISTA
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State | AR
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Zip | 72715-2307
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Country | US
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Telephone | 316-303-2810
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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 |
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License Number State |
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