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General NPI Number Information
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NPI Number | 1518074913
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Entity Type | Individual
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Provider Name | ANNE VOUGHT ELLIS PT
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Gender | Female
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1 FREEDOM WAY VAMC SCIU 28
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City | AUGUSTA
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State | GA
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Zip | 30904-6258
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Country | US
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Telephone | 706-733-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 713 HAMMOND DR
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City | NORTH AUGUSTA
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State | SC
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Zip | 29841-3227
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Country | US
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Telephone | 803-279-5419
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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 | 4734
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License Number State | SC
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