MEDICARE: ASHLEY ELLIS 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
1	225100000X	Physical Therapist	1343090	TX

General Provider Information

NPI Number	:	1639756596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY ELLIS DPT

Provider Business Mailing Address
First Line	:	7015 MAID STONE DR
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77505-3857
Country	:	US
Telephone Number	:	281-309-7023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 CLEAR LAKE CITY BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-8102
Country	:	US
Telephone Number	:	832-224-4735
Fax Number	:

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

Provider Enumeration Date	:	03/26/2021
Last Update Date	:	03/26/2021

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Directions to “ ASHLEY ELLIS DPT” Practice Location

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