Jack Ellis, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTH4693 Issued in AL

Practice address

820 University Blvd
Birmingham, AL 35233-1111

Phone

(205) 327-5030

Fax

(205) 327-5616

NPI assigned

Nov 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Vincents Ambulatory Healthcare Network LLC

  • Physical Therapy Clinic/Center
  • Birmingham, AL
  • NPI 1891212494
  Medicare reassignment NPD
• St Vincents Ambulatory Healthcare Network LLC

  • Registered Dietitian
  • Birmingham, AL
  • NPI 1982121513
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033289525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 UNIVERSITY BLVD",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331111",
            "telephone_number": "205-327-5030",
            "fax_number": "205-327-5616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 UNIVERSITY BLVD",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331111",
            "telephone_number": "205-327-5030",
            "fax_number": "205-327-5616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JACK",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH4693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blakely Ellis, AUD
• Brandi Michelle Ellis, PHD
• Brennan Phillip Ellis, CRNP
• Charles H. Ellis, DMD
• Frank Ellis, AGACNP
• Kelli S Ellis, M.S. CCC-SLP
• Richard Leroy Ellis, MD
• Shannon B Ellis, M.D.
• Brandon Taylor Ellison
• Brian Ellison

• Physical Therapist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Physical Therapist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.