Provider Demographics
NPI:1033142880
Name:ELLIS, SCOTT A (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:ELLIS
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-3239
Mailing Address - Country:US
Mailing Address - Phone:973-459-1456
Mailing Address - Fax:
Practice Address - Street 1:4321 HARTWICK RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3210
Practice Address - Country:US
Practice Address - Phone:973-459-1456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer