Provider Demographics
NPI:1124030853
Name:STOKES, LUCILLE ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:ELLEN
Last Name:STOKES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2028
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7028
Mailing Address - Country:US
Mailing Address - Phone:903-675-0077
Mailing Address - Fax:903-675-0078
Practice Address - Street 1:907 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3612
Practice Address - Country:US
Practice Address - Phone:903-675-0077
Practice Address - Fax:903-675-0078
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1032209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83368TOtherBLUE CROSS/BLUE SHIELD
TX83368TOtherBLUE CROSS/BLUE SHIELD