Individual
ANTHONETTA ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
622 HEATHER TRL APT 1105, ARLINGTON, TX 76011-3759
(214) 397-7002
Mailing address
622 HEATHER TRL APT 1105, ARLINGTON, TX 76011-3759
(214) 397-7002
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
332H00000X
Eyewear Supplier
—
—
335E00000X
Prosthetic/Orthotic Supplier
—
—
Other
Enumeration date
01/08/2026
Last updated
02/27/2026
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