Provider Demographics
NPI:1699404558
Name:ELLIS, TYLER (ATC)
Entity Type:Individual
Prefix:MR
First Name:TYLER
Middle Name:
Last Name:ELLIS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 HAMILTON DR
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3140
Mailing Address - Country:US
Mailing Address - Phone:856-777-2681
Mailing Address - Fax:
Practice Address - Street 1:1750 KRESSON RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2590
Practice Address - Country:US
Practice Address - Phone:856-424-2222
Practice Address - Fax:856-761-0856
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer