Provider Demographics
NPI:1235780917
Name:ELLIS, ARCELIA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ARCELIA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:ARCELIA
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMT
Mailing Address - Street 1:8251 LARIAT TRL NW
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-9122
Mailing Address - Country:US
Mailing Address - Phone:360-649-0147
Mailing Address - Fax:
Practice Address - Street 1:8251 LARIAT TRL NW
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-9122
Practice Address - Country:US
Practice Address - Phone:360-551-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61007391225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist