Individual
MR. ERIC DANIEL ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LAT, ATC
Contact information
Practice address
414 BRYAN ST, HAVERTOWN, PA 19083-4311
(484) 680-6341
(610) 359-1686
Mailing address
414 BRYAN ST, HAVERTOWN, PA 19083-4311
(484) 680-6341
(610) 359-1686
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
RT004288
PA
Other
Enumeration date
04/23/2014
Last updated
04/23/2014
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