Individual
CHRIS ROBERT ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
16849 MALLARD LN, LOCKPORT, IL 60441-1309
(708) 476-0350
Mailing address
16849 MALLARD LN, LOCKPORT, IL 60441-1309
(708) 476-0350
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
160.006451
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
160.006451
IL PT LICENSE
IL
Enumeration date
01/25/2016
Last updated
01/25/2016
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