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NPI Code Detail

MEDICARE: JILL MARIE ELLIS PTA

MEDICARE:   JILL MARIE ELLIS  PTA
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
1225200000XPhysical Therapy Assistant5502000113MI

General Provider Information

NPI Number : 1740780337
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL MARIE ELLIS PTA
Provider Business Mailing Address
First Line : 1310 GEORGE ST
Second Line :
City : LANSING
State : MI
Zip : 48910-1235
Country : US
Telephone Number : 517-862-0800
Fax Number :
Provider Business Practice Location Address
First Line : 3394 E JOLLY RD STE B
Second Line :
City : LANSING
State : MI
Zip : 48910-8595
Country : US
Telephone Number : 517-975-3520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/20/2018
Last Update Date : 02/20/2018

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Directions to “ JILL MARIE ELLIS PTA” Practice Location

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