Provider Demographics
NPI:1295972404
Name:ELLIS, KAREN (PT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:ELLIS
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 1:484 RIVER HWY
Mailing Address - Street 2:UNIT C
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6828
Mailing Address - Country:US
Mailing Address - Phone:704-660-0096
Mailing Address - Fax:
Practice Address - Street 1:484 RIVER HWY
Practice Address - Street 2:UNIT C
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-6828
Practice Address - Country:US
Practice Address - Phone:704-660-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist