Individual
MICHAEL JOHN ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CTRS
Contact information
Practice address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-2511
Mailing address
113 COMANCHE RD, FORT MEADE, SD 57741-1002
(605) 347-2511
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
27699
SD
Other
Enumeration date
07/29/2025
Last updated
07/29/2025
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