Provider Demographics
NPI:1902279946
Name:LIM QUEE, ELLIS TROY (PTA)
Entity Type:Individual
Prefix:
First Name:ELLIS
Middle Name:TROY
Last Name:LIM QUEE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 ADIRONDACK CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5666
Mailing Address - Country:US
Mailing Address - Phone:407-860-4071
Mailing Address - Fax:
Practice Address - Street 1:1251 ADIRONDACK CT
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5666
Practice Address - Country:US
Practice Address - Phone:407-860-4071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26162225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant