Provider Demographics
NPI:1699390385
Name:ELLARD PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ELLARD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ELLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:601-600-2515
Mailing Address - Street 1:290 SGT PRENTISS DR STE A
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4142
Mailing Address - Country:US
Mailing Address - Phone:601-600-2515
Mailing Address - Fax:601-600-2515
Practice Address - Street 1:290 SGT PRENTISS DR STE A
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4142
Practice Address - Country:US
Practice Address - Phone:601-600-2515
Practice Address - Fax:601-600-2515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty