Ellis, Jay T
Ellis, Jay T is an individual health care provider with primary practice located at 3100 S Woodruff Ave , Idaho Falls ID 83404-8310. He recently has only one registered license in Other Service Providers / Contractor, which is considered as his primary health care specialty. Ellis, Jay T can be contacted via phone (208) 523-8879.Contact Information
Primary practice address
3100 S Woodruff Ave
Idaho Falls ID 83404-8310
Phone: (208) 523-8879
Fax: (208) 523-0436
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Contractor | 171W00000X | RPT231 | Idaho |
Profile Details
| NPI number | 1811924012 |
|---|---|
| LBN Legal business name | Ellis, Jay T |
| Credentials | PT, DPT, CSCS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 26th, 2006 |
| Last updated | Mar 4th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1811924012 | NPPES |
| Idaho | Other | 316942 | BLUE SHIELD |
| Idaho | MEDICAID | 804274500 | BLUE SHIELD |
| Idaho | Other | T0742 | BLUE SHIELD |
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