Individual
MR. BRADLEY WADE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4820 NEWBERRY ROAD, GAINESVILLE, FL 32607
(352) 373-2116
(352) 373-1507
Mailing address
19293 NW 230TH ST, HIGH SPRINGS, FL 32643
(352) 328-6427
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19813
FL
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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