Individual
JACQUELINE MARION ELLIS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
90 SOUTHSIDE AVE, SUITE 225, ASHEVILLE, NC 28801-4160
(828) 254-3525
(828) 254-0792
Mailing address
90 SOUTHSIDE AVE, SUITE 225, ASHEVILLE, NC 28801-4160
(828) 254-3525
(828) 254-0792
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1710
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
078PW
BCBS
NC
Enumeration date
08/10/2005
Last updated
07/08/2007
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