Individual
DR. CHERYL LYNN ELLISOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
3201 S LOOP 256, PALESTINE, TX 75801-6901
(903) 723-0330
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1117216
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1U4936
MEDICARE
TX
05
—
430137601
—
TX
Enumeration date
10/14/2014
Last updated
03/17/2022
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