Provider Demographics
NPI:1417088287
Name:ELLIS, CHRISTINE (LMT, AP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:LMT, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 NW 6TH ST
Mailing Address - Street 2:SUITE E-1
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2226
Mailing Address - Country:US
Mailing Address - Phone:352-376-0309
Mailing Address - Fax:
Practice Address - Street 1:1031 NW 6TH ST
Practice Address - Street 2:SUITE E-1
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2226
Practice Address - Country:US
Practice Address - Phone:352-376-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1367171100000X
FLMA13236225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171100000XOther Service ProvidersAcupuncturist
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0656OtherBCBS OF FL
FLC5218OtherBCBS OF FL