Individual
MRS. SHANNON M ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5775 OLD WINDER HWY, BRASELTON, GA 30517-1603
(678) 866-4104
Mailing address
3576 PHOENIX COVE DR, GAINESVILLE, GA 30506-4669
(574) 286-2559
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002735
GA
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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