Individual
ALLISON DENISE ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
1628 19TH ST, LUBBOCK, TX 79401-4832
(806) 219-0500
(806) 766-1286
Mailing address
1628 19TH ST, LUBBOCK, TX 79401-4832
(806) 219-0500
(806) 766-1286
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1146986
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
114986
EXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS
TX
05
—
1754251-01
—
TX
Enumeration date
04/09/2007
Last updated
07/03/2024
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