Individual
KYLIE ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2140 W GRANDE BLVD, SUITE A, TYLER, TX 75703-0563
(903) 521-1358
Mailing address
5353 KELLER SPRINGS RD, 1522, DALLAS, TX 75248-2778
(903) 521-1358
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT110273
TX
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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