Individual
MR. KELLY WYNELL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5502 SAN JUAN DR, TOLEDO, OH 43612-3336
(419) 410-7741
Mailing address
5502 SAN JUAN DR, TOLEDO, OH 43612-3336
(419) 410-7741
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PTA007644
OH
Other
Enumeration date
04/14/2020
Last updated
04/14/2020
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