Organization
GENTIVA
Active
Other names
mid-south
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK ANTHONY ELLIS JR. MS, PT, CMT (PHYSICAL THERAPIST)
(205) 914-8588
Entity
Organization
Contact information
Practice address
2200 RIVERCHASE CTR STE 700, BIRMINGHAM, AL 35244-2915
(205) 739-7800
Mailing address
2034 FOREST LAKES LN, STERRETT, AL 35147-8151
(205) 914-8588
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH4693
AL
Other
Enumeration date
03/26/2007
Last updated
08/22/2020
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