MEDICARE: STEPHANIE ELIZABETH ELLIS

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	14206	TN

General Provider Information

NPI Number	:	1194468322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE ELIZABETH ELLIS

Provider Business Mailing Address
First Line	:	PO BOX 306556
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37230-6556
Country	:	US
Telephone Number	:	615-329-2294
Fax Number	:	615-695-1494

Provider Business Practice Location Address
First Line	:	2160 ROCK SPRINGS RD STE 100
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6110
Country	:	US
Telephone Number	:	615-267-6600
Fax Number	:	615-267-6603

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

Provider Enumeration Date	:	04/15/2022
Last Update Date	:	12/04/2025

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