Individual
JOHN ELLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPO
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
1305
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110686-01
—
TX
01
—
1276950002
MEDICARE PTAN
TX
Enumeration date
12/02/2014
Last updated
12/02/2014
Update your record
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