Individual
MICHAEL ELLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 VILLANOVA RD, GLASSBORO, NJ 08028-1558
(765) 744-1623
Mailing address
410 VILLANOVA RD, GLASSBORO, NJ 08028-1558
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
008410-1
NY
225200000X
Physical Therapy Assistant
Primary
40QB00328000
NJ
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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