Individual
JENNIFER L ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
7440 N SHADELAND AVE, SUITE 130, INDIANAPOLIS, IN 46250-2029
(317) 577-7333
(317) 577-7330
Mailing address
1530 SAINT JOHN CT S, BEECH GROVE, IN 46107-2631
(317) 408-2752
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
05004851A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05004851A
PHYSICAL THERAPIST LICENS
IN
Enumeration date
01/03/2006
Last updated
07/09/2007
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