Provider Demographics
NPI:1699018366
Name:ELLERBEE, JOHN M (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:ELLERBEE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CRESCENT RD
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-7457
Mailing Address - Country:US
Mailing Address - Phone:706-938-0953
Mailing Address - Fax:
Practice Address - Street 1:1435 N EXPRESSWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-9016
Practice Address - Country:US
Practice Address - Phone:770-227-4049
Practice Address - Fax:770-412-7009
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist