Individual
MR. MICHAEL WILLIAM ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
12441 SE STARK ST, PORTLAND, OR 97233-1053
(503) 255-7040
Mailing address
3123 NE 29TH ST APT 306, GRESHAM, OR 97030-4372
(971) 320-9799
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
09797
PA
Other
Enumeration date
09/05/2019
Last updated
09/05/2019
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