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NPI Code Detail

MEDICARE: SEAN BRETT ELLIS DPT

MEDICARE: SEAN BRETT 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
1225100000XPhysical Therapist5501015801MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15501015801OTHERMILICENSE

General Provider Information

NPI Number : 1861763344
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN BRETT ELLIS DPT
Provider Business Mailing Address
First Line : 33900 HARPER AVE
Second Line : SUITE 104
City : CLINTON TOWNSHIP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-416-9100
Fax Number :
Provider Business Practice Location Address
First Line : 2771 OAK VALLEY DR
Second Line :
City : ANN ARBOR
State : MI
Zip : 48103-9244
Country : US
Telephone Number : 734-821-7500
Fax Number : 734-821-7501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2012
Last Update Date : 08/30/2023

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Directions to “ SEAN BRETT ELLIS DPT” Practice Location

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