Individual
MRS. BETHANY ANN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5545 HIGHWAY 145, SHANNON, MS 38868-9351
(662) 871-6638
Mailing address
5545 HIGHWAY 145, SHANNON, MS 38868-9351
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA3896
MS
Other
Enumeration date
08/31/2010
Last updated
08/31/2010
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