Individual
NICOLE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
7419 GRANBY ST, NORFOLK, VA 23505-3406
(757) 489-5820
(757) 489-5822
Mailing address
7419 GRANBY ST, NORFOLK, VA 23505-3406
(757) 489-5820
(757) 489-5822
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2305205979
VA
225100000X
Physical Therapist
2305205979
VA
Other
Enumeration date
08/26/2009
Last updated
08/26/2009
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