Individual
MR. DOUGLAS A ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
3233 W CHARLESTON BLVD, STE 107, LAS VEGAS, NV 89102-1938
(702) 258-9381
(702) 258-9584
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0149
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265404388
—
NV
01
—
DL668Z
MEDICARE PTAN
—
Enumeration date
02/02/2006
Last updated
09/03/2015
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