Individual
JACOB ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3700 WASHINGTON AVE, EVANSVILLE, IN 47714-0541
(812) 485-5621
Mailing address
1528 ROSSMAY DR, WESTFIELD, IN 46074-7931
(317) 809-6352
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
05015247A
IN
Other
Enumeration date
11/08/2023
Last updated
11/08/2023
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