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NPI Code Detail

MEDICARE: DR. NATHAN PATRICK ELLIS PT, DPT

MEDICARE: DR. NATHAN PATRICK ELLIS PT, DPT
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
1225100000XPhysical Therapist6412NV

General Provider Information

NPI Number : 1003658568
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHAN PATRICK ELLIS PT, DPT
Provider Business Mailing Address
First Line : 10769 PASTEL SUNSET CT
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1582
Country : US
Telephone Number : 307-231-4467
Fax Number :
Provider Business Practice Location Address
First Line : 6823 PONDEROSA WAY
Second Line :
City : LAS VEGAS
State : NV
Zip : 89118-2100
Country : US
Telephone Number : 702-665-4054
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2024
Last Update Date : 06/06/2024

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