Provider Demographics
NPI:1194934232
Name:ELLISON, JOYCE E (PTA)
Entity type:Individual
Prefix:MISS
First Name:JOYCE
Middle Name:E
Last Name:ELLISON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 HADDON CT
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-7326
Mailing Address - Country:US
Mailing Address - Phone:864-409-0719
Mailing Address - Fax:843-571-2124
Practice Address - Street 1:1941 SAVAGE RD
Practice Address - Street 2:SUITE 400C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4704
Practice Address - Country:US
Practice Address - Phone:843-571-2700
Practice Address - Fax:843-571-2124
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant