Individual
LISA GUNTER ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4101 S MEDFORD DR, LUFKIN, TX 75901-5633
(936) 639-1141
(936) 633-5695
Mailing address
4101 S MEDFORD DR, LUFKIN, TX 75901-5633
(936) 639-1141
(936) 633-5695
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
1165899
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8T6242
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/12/2006
Last updated
07/09/2007
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