Individual
MICHAEL RAYMOND ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.A.
Contact information
Practice address
1655 RICHMOND AVE, SUITE B102, STATEN ISLAND, NY 10314-1570
(718) 370-3500
(718) 370-9724
Mailing address
1715 AVENUE T, SUITE 2F, BROOKLYN, NY 11229-3429
(718) 336-8206
(718) 336-8209
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
003487-1
NY
Other
Enumeration date
11/07/2007
Last updated
11/07/2007
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