Active NPI
Lisa Gunter Ellis, PT
- Pediatric Physical Therapist
- Lufkin, TX
National Provider Identifier
1275604332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1165899
- Practice address
- 4101 S Medford Dr
Lufkin, TX 75901-5633 - Phone
- (936) 639-1141
- Fax
- (936) 633-5695
- NPI assigned
- Nov 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1165899 | TX | Primary |
Addresses
Primary practice location
4101 S Medford Dr
Lufkin, TX 75901-5633
Mailing address
4101 S Medford Dr
Lufkin, TX 75901-5633
Phone (936) 639-1141
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8T6242 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1165899 | TX | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1275604332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4101 S MEDFORD DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759015633",
"telephone_number": "936-639-1141",
"fax_number": "936-633-5695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 S MEDFORD DR",
"city": "LUFKIN",
"state": "TX",
"postal_code": "759015633",
"telephone_number": "936-639-1141",
"fax_number": "936-633-5695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "LISA",
"middle_name": "GUNTER",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-12",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "1165899",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "8T6242",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lufkin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.