Individual
KELLY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, LMT
Contact information
Practice address
600 W NORTH BLVD, LEESBURG, FL 34748-5063
(352) 787-9300
Mailing address
600 W NORTH BLVD, LEESBURG, FL 34748-5063
(352) 787-9300
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
30011
FL
225700000X
Massage Therapist
72444
FL
Other
Enumeration date
04/06/2021
Last updated
04/06/2021
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