Individual
JACK ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
820 UNIVERSITY BLVD, BIRMINGHAM, AL 35233-1111
(205) 327-5030
(205) 327-5616
Mailing address
820 UNIVERSITY BLVD, BIRMINGHAM, AL 35233-1111
(205) 327-5030
(205) 327-5616
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH4693
AL
Other
Enumeration date
11/09/2006
Last updated
07/08/2007
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