Most Relevant Information
Provider Data
| NPI Number: | 1003403908 |
| Provider Name: | ELLIE VICTORIA MICHAEL PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 4556 |
Most Important Dates
| Enumeration Date: | 12/25/2020 |
| Last Updated: | 12/25/2020 |
Provider Practice Location
1305 BOILING SPRINGS RD
GREER
SC
296504139
Practice Location Phone/Fax
| Phone: | 8644587566 |
| Fax: |
Provider Mailing Location
184 CAROLINA OAKS DR
FOUNTAIN INN
SC
296448506
Provider Mailing Phone/Fax
| Phone: | 8646120727 |
| Fax: |