Individual
CLAYTON KYLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
6 E OAK ST, MC RAE, GA 31055-4337
(229) 868-2174
Mailing address
1409 ACTON DR, VIDALIA, GA 30474-4306
(229) 310-0318
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002897
GA
Other
Enumeration date
08/06/2012
Last updated
08/06/2012
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