Individual
KAROLYN G ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICAL THERAPIST
Contact information
Practice address
722 S 8TH ST, CANON CITY, CO 81212-4906
(719) 345-4097
Mailing address
722 S 8TH ST, CANON CITY, CO 81212-4906
(719) 345-4097
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1502
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1502
STATE OF COLORADO
CO
Enumeration date
09/08/2011
Last updated
09/08/2011
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