Organization
ELLIS REHABILITATION SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ELLIS PT (PRESIDENT/ADMINISTRATOR)
(903) 675-0000
Entity
Organization
Contact information
Practice address
5609 DONNYBROOK AVE, TYLER, TX 75703-6111
(903) 561-2808
(903) 939-1812
Mailing address
115 S MURCHISON ST, ATHENS, TX 75751-2662
(903) 675-0000
(903) 675-5520
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0094BG
BCBS
TX
05
—
110019002
—
TX
05
—
110019004
—
TX
01
—
122300
CHIPS
TX
Enumeration date
08/09/2006
Last updated
02/09/2010
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