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Individual

JEFF ELLIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATC

Contact information

Practice address
196 W SPROUL RD, SPRINGFIELD, PA 19064-2045
(610) 328-8830
Mailing address
196 W SPROUL RD, SPRINGFIELD, PA 19064-2045

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
J30000275
DE
2255A2300X
Athletic Trainer
Primary
RT003160
PA

Other

Enumeration date
04/23/2015
Last updated
04/23/2015
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