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1811924012
JAY T ELLIS
IDAHO FALLS, ID
NPI
1811924012
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171W00000X Contractor
(Licence: ID RPT231)
Enumeration Date
2006-06-26
Last Update Date
2011-03-04
Business Address
-- JAY T ELLIS PT, DPT, CSCS
3100 S WOODRUFF AVE
IDAHO FALLS, ID 83404-8310
Phone number: 208-523-8879
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Mailing Address
-- JAY T ELLIS PT, DPT, CSCS
PO BOX 1463
IDAHO FALLS, ID 83403-1463
Phone number: 208-523-8879
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