Provider Demographics
NPI:1396942496
Name:HO-ELLSWORTH, THUY NHU (DPM)
Entity type:Individual
Prefix:
First Name:THUY
Middle Name:NHU
Last Name:HO-ELLSWORTH
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:THUY
Other - Middle Name:NHU
Other - Last Name:HO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4015
Mailing Address - Fax:512-901-3935
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4015
Practice Address - Fax:512-901-3935
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000215A213E00000X
TX1929213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00937904OtherRRMC
TX215080701Medicaid
TX215080701Medicaid