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Individual
MS. VIVIAN BEATRICE ELLIS
Active
Individual
MS. VIVIAN BEATRICE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1033876
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0069361
BCBS BLUE LINK
TX
01
—
8T0329
BCBS PAR PLAN PROVIDER #
TX
Enumeration date
05/23/2005
Last updated
06/04/2018
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