Individual
JANENNE E ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
10000 BEACH DR SW UNIT 9, CALABASH, NC 28467-2856
(910) 579-2745
(910) 579-2847
Mailing address
10000 BEACH DR SW UNIT 9, CALABASH, NC 28467-2856
(910) 579-2745
(910) 579-2847
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
P2997
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1131H
BLUE CROSS BLUE SHIELD NC
NC
01
—
1180992
FIRSTHEALTH/MAILHANDLERS
NC
01
—
125357800
US DEPART OF LABOR
NC
01
—
501889202
TRICARE
NC
01
—
E2499
MEDCOST PROVIDER #
NC
Enumeration date
06/08/2006
Last updated
08/12/2020
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