Bradley Wade Ellis

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA19813 Issued in FL

Practice address

4820 Newberry Road
Gainesville, FL 32607

Phone

(352) 373-2116

Fax

(352) 373-1507

NPI assigned

Jan 30, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Request Physical Therapy

  • Physical Therapist
  • Gainesville, FL
  • NPI 1245225085
  NPD (past)

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639215031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19293 NW 230TH ST",
            "city": "HIGH SPRINGS",
            "state": "FL",
            "postal_code": "32643",
            "telephone_number": "352-328-6427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4820 NEWBERRY ROAD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "32607",
            "telephone_number": "352-373-2116",
            "fax_number": "352-373-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "BRADLEY",
        "middle_name": "WADE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA19813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leighton Andrew Elliott, MD
• Lisa C Elliott, CNMT, RT(N)
• Titus Elliott
• Ellis Shuttle Services, LLC
• Beth Harper Ellis, M.D.
• Christine Ellis, L.M.T., A.P.
• Frank D Ellis, M.D.
• Kanardra Ellis
• Katyra Ellis
• Matthew S Ellis, MD

• Physical Therapy Assistant in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Physical Therapy Assistant in Florida

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.