Provider Demographics
NPI:1295811347
Name:ELLINGTON, KRIS J (PT)
Entity type:Individual
Prefix:MRS
First Name:KRIS
Middle Name:J
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13947 PERRY
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-4568
Mailing Address - Country:US
Mailing Address - Phone:734-284-5994
Mailing Address - Fax:
Practice Address - Street 1:3200 BIDDLE ST
Practice Address - Street 2:3RD FL
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-5937
Practice Address - Country:US
Practice Address - Phone:734-324-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist