Individual
RALPH ELLIS IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1020 TITAN CT STE 102, FORT WALTON BEACH, FL 32547-6638
(850) 863-7581
Mailing address
1151 MAPOLES ST, CRESTVIEW, FL 32536-2627
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA34467
FL
Other
Enumeration date
02/18/2026
Last updated
02/18/2026
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