Individual
ELISA SANDOVAL BOESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
6202 82ND ST, LUBBOCK, TX 79424-3691
(806) 687-8008
(806) 687-8009
Mailing address
2431 S LOOP 289, LUBBOCK, TX 79423-1519
(806) 771-8008
(806) 771-8009
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1233151
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
328096801
—
TX
01
—
8DX137
BLUE CROSS BLUE SHIELD
TX
01
—
P01415270
MEDICARE RAILROAD
TX
Enumeration date
08/08/2013
Last updated
12/15/2017
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