Healthcare Provider Details

I. General information

NPI: 1447921655
Provider Name (Legal Business Name): LINDSEY ELLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 RIDGE RD
ROCKWALL TX
75032-5806
US

IV. Provider business mailing address

2431 S LOOP 289
LUBBOCK TX
79423-1519
US

V. Phone/Fax

Practice location:
  • Phone: 469-887-1021
  • Fax:
Mailing address:
  • Phone: 806-771-8008
  • Fax: 806-771-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2163772
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: