Provider Demographics
NPI:1104263433
Name:ELLIS, APRIL MICHELLE (DPT)
Entity type:Individual
Prefix:MRS
First Name:APRIL
Middle Name:MICHELLE
Last Name:ELLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:APRIL
Other - Middle Name:MICHELLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:484 CHURCH RD E
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9714
Mailing Address - Country:US
Mailing Address - Phone:662-349-2966
Mailing Address - Fax:662-349-2966
Practice Address - Street 1:484 CHURCH RD E
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9714
Practice Address - Country:US
Practice Address - Phone:662-349-2966
Practice Address - Fax:662-349-2966
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7976225100000X
MS5281225100000X
TN9621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist