James Ryan Ellis, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA6404 Issued in MS

Practice address

321 Flora Gene Ave W Ste D
Wiggins, MS 39577-5010

Phone

(601) 523-1994

Fax

(601) 523-1995

NPI assigned

May 21, 2018

Last updated

May 21, 2018By 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.

• Flint Creek Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Wiggins, MS
  • NPI 1972028520
  NPD (past)

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

{
    "created_epoch": "1526860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1801387428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 FLORA GENE AVE W STE D",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395775010",
            "telephone_number": "601-523-1994",
            "fax_number": "601-523-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 FLORA GENE AVE W STE D",
            "city": "WIGGINS",
            "state": "MS",
            "postal_code": "395775010",
            "telephone_number": "601-523-1994",
            "fax_number": "601-523-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JAMES",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-21",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MS",
            "license": "PTA6404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph R Dunn, PHD
• Rebecca Lee Dyess, LPTA
• Elite Mississippi Transit Inc
• Elite Mississippi Transportation LLC
• Elite Transit LLC
• Belinda Evans
• La'Toria Evans, LPTA
• Teketra Evans, LPN, COSMETOLOGIST
• Tori Fairley
• Flint Creek Physical Therapy, LLC

• Physical Therapy Assistant in Wiggins, MS
• Providers in Wiggins, MS by specialty
• Physical Therapy Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; 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.