Healthcare Provider Details

I. General information

NPI: 1124030853
Provider Name (Legal Business Name): LUCILLE ELLEN STOKES PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 S PALESTINE ST
ATHENS TX
75751-3612
US

IV. Provider business mailing address

PO BOX 2028
ATHENS TX
75751-7028
US

V. Phone/Fax

Practice location:
  • Phone: 903-675-0077
  • Fax: 903-675-0078
Mailing address:
  • Phone: 903-675-0077
  • Fax: 903-675-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1032209
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: