Individual
LISA K ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSR, PT
Contact information
Practice address
600 GAULT AVE S, FORT PAYNE, AL 35967-1626
(256) 844-2992
Mailing address
600 GAULT AVE S, FORT PAYNE, AL 35967-1626
(256) 844-2992
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
7197
GA
225100000X
Physical Therapist
Primary
PTH5238
AL
Other
Enumeration date
03/11/2008
Last updated
03/11/2008
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