Individual
CHARLES MICHAEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., ATC
Contact information
Practice address
2000 BERRY CHASE PL, MONTGOMERY, AL 36117-6896
(334) 356-6453
(334) 239-8126
Mailing address
7449 EASTCHASE PKWY, STE 200, MONTGOMERY, AL 36117-6846
(334) 747-4030
(334) 747-4031
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH1388
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
890013760
—
AL
Enumeration date
06/22/2006
Last updated
01/04/2022
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