Individual
ANN PEYTON ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
600 N GRAND AVE, TAHLEQUAH, OK 74464-2301
(918) 456-5511
Mailing address
132 GLEN IVES WAY, MADISON, AL 35758-4606
(256) 698-8809
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
05/23/2017
Last updated
05/23/2017
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