Individual
TIMOTHY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1200 PROVIDENCE RD, WAYNE, NE 68787-1212
(402) 375-7937
(402) 375-7956
Mailing address
1200 PROVIDENCE RD, WAYNE, NE 68787-1212
(402) 375-7937
(402) 375-7956
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
54
NE
Other
Enumeration date
03/15/2016
Last updated
03/15/2016
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