Individual
DR. ROBERT RAY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4016 CASSIMER AVE, DIBERVILLE, MS 39540-2309
(228) 326-1115
Mailing address
4016 CASSIMER AVE, DIBERVILLE, MS 39540-2309
(228) 326-1115
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
PT5070
MS
225100000X
Physical Therapist
Primary
PT5070
MS
Other
Enumeration date
09/21/2012
Last updated
12/15/2023
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