Doctor Name: | KEITH ELLIS |
NPI Number: | 1972823367 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PT |
License Number: | 05010042A |
Business Practice Address: | 1496 Pope Ct Suite 3 Chesterton, IN - 463045302 |
Business Phone Number: | 2199268522 |
Business Fax Number: | 2199267513 |
Mailing Address: | 1496 Pope Ct, Suite 3 CHESTERTON |
State: | IN |
Postal Code: | 463045302 |
Phone Number: | 2199268522 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2010 |
NPI Last Update Date: | 06/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225100000X |
License Number: | 05010042A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |