Individual
LORA NICOLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
7381 S SIWELL RD, STE A, BYRAM, MS 39272-8741
(601) 373-2075
(601) 373-2077
Mailing address
7381 S SIWELL RD, STE A, BYRAM, MS 39272-8741
(601) 373-2075
(601) 373-2077
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4540
MS
Other
Enumeration date
02/26/2010
Last updated
02/06/2012
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