Individual
TERRY ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1402 MAIN ST, BLOOMER, WI 54724-1637
(715) 568-4669
Mailing address
11188 16TH AVE, CHIPPEWA FALLS, WI 54729-6505
(715) 832-5519
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
562-019
WI
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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