Organization
ELLMAN REHAB ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL GARY ELLMAN MD (PYSICIAN OWNER)
(972) 682-3909
Entity
Organization
Contact information
Practice address
2692 N GALLOWAY #402, MESQUITE, TX 75150-6360
(972) 682-3909
(972) 682-9289
Mailing address
PO BOX 850304, MESQUITE, TX 75185-0304
(972) 682-3909
(972) 682-9289
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J3092
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074QG
BCBS
TX
01
—
00Y500
MEDICARE GROUP
TX
05
—
12249902
—
TX
01
—
J3092
STATE LICENCE NUMBER
TX
Enumeration date
04/02/2007
Last updated
02/06/2013
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