NPI 1811924012

Jay T Ellis, PTDPTCSCS

Practitioner Contractor Idaho Falls, ID

Practice location

Address: 3100 S Woodruff Ave, Idaho Falls, ID 83404-8310
Phone: (208) 523-8879
Fax: (208) 523-0436
Mailing address: PO Box 1463, Idaho Falls, ID 83403-1463

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence RPT231 (ID)

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Registry record

NPI: 1811924012
Entity type: Individual
Sex (as registered): Male
NPI issued: 26 Jun 2006
Record last updated: 4 Mar 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.