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Individual
STACI GAYE ELLIS
Active
Individual
STACI GAYE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7361
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00007361
PT LICENSE
WA
Enumeration date
07/26/2005
Last updated
06/03/2019
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