Individual
SARA JANE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1406 6TH AVE N, SAINT CLOUD, MN 56303
(320) 229-4922
(320) 229-5183
Mailing address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1901
(320) 229-4922
(320) 229-5183
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6210
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088475800
—
MN
01
—
382S9EL
BLUE CROSS BLUE SHIELD
MN
01
—
64-03510
MEDICA AND SELECT CARE
MN
01
—
HP30970
HEALTHPARTNERS
MN
01
—
P00024072
RAILROAD MEDICARE
MN
Enumeration date
10/24/2006
Last updated
08/28/2018
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