Provider Demographics
NPI:1124013008
Name:ELLIS, TIMOTHY EDWARD (DPT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:EDWARD
Last Name:ELLIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MALL LOOP RD
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7656
Mailing Address - Country:US
Mailing Address - Phone:336-781-4320
Mailing Address - Fax:336-781-4321
Practice Address - Street 1:319A JULIAN AVE
Practice Address - Street 2:HEALTHCARE CONSULTANTS INC
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-4832
Practice Address - Country:US
Practice Address - Phone:336-472-6566
Practice Address - Fax:336-472-5281
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7894225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2504001OtherMEDICARE - TYPE UNSPECIFIED
NC078GJOtherBCBS