Individual
IVY ROSE EMBELLADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
402 S. JOHN REDDITT DR., LUFKIN, TX 75904
(936) 632-2107
(936) 632-2108
Mailing address
402 S JOHN REDDITT DR, LUFKIN, TX 75904-3108
(936) 632-2107
(936) 632-2108
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2116958
TX
Other
Enumeration date
12/17/2015
Last updated
12/17/2015
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