Provider Demographics
NPI:1396275301
Name:ELLIS, SANDRA (DPT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DULVERTON DR
Mailing Address - Street 2:
Mailing Address - City:BELLA VISTA
Mailing Address - State:AR
Mailing Address - Zip Code:72715-2307
Mailing Address - Country:US
Mailing Address - Phone:316-303-2810
Mailing Address - Fax:
Practice Address - Street 1:642 W LANCASHIRE BLVD
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72715-3027
Practice Address - Country:US
Practice Address - Phone:479-876-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist