Individual
MRS. MICHELLE C ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P. T.
Contact information
Practice address
276 NISSAN PKWY, SUITE 400, BLDG F, CANTON, MS 39046-7006
(601) 859-3776
(601) 859-3778
Mailing address
2416 HIGHWAY 45 N, COLUMBUS, MS 39705-1320
(662) 327-6705
(662) 327-6760
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
MS PT0747
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5965404
AETNA
MS
Enumeration date
10/19/2006
Last updated
12/28/2016
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