Individual
AUTUMN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
834 PINEBROOK RD, VENICE, FL 34285-7123
(941) 484-8107
(941) 484-5186
Mailing address
834 PINEBROOK RD, VENICE, FL 34285-7123
(941) 484-8107
(941) 484-5186
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PENDING
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT34734
PHYSICAL THERAPIST LICENSE
FL
Enumeration date
06/10/2019
Last updated
02/16/2021
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