Ivy Rose Embellado, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2116958 Issued in TX

Practice address

402 S. John Redditt Dr.
Lufkin, TX 75904

Phone

(936) 632-2107

Fax

(936) 632-2108

NPI assigned

Dec 17, 2015

Last updated

Dec 17, 2015By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Angelina Rehabilitation Center, LLC

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Lufkin, TX
  • NPI 1912089962
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1450310400000",
    "number": "1437514478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 S JOHN REDDITT DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043108",
            "telephone_number": "936-632-2107",
            "fax_number": "936-632-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 S. JOHN REDDITT DR.",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "75904",
            "telephone_number": "936-632-2107",
            "fax_number": "936-632-2108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMBELLADO",
        "first_name": "IVY ROSE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-17",
        "last_updated": "2015-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2116958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elliott Chiropractic Clinic, Inc.
• Lisa Elliott
• Steven Ray Elliott, D.C.
• Keven M Ellis, D.C.
• Lisa Gunter Ellis, PT
• Emergency Physician Care of Garland, PLLC
• David Kent Emmerling, RPH
• Annysue Crystalin Emmons, DNP, FNP-C
• Epic Cardiology PLLC
• Epic Internal Medicine PLLC

• Physical Therapy Assistant in Lufkin, TX
• Providers in Lufkin, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.