Healthcare Provider Details

I. General information

NPI: 1780993550
Provider Name (Legal Business Name): ELIZABETH SUSAN CALABRIA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 09/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5114 BALCONES WOODS DR SUITE 306
AUSTIN TX
78759-5273
US

IV. Provider business mailing address

12410 ALAMEDA TRACE CIR #1823
AUSTIN TX
78727-6492
US

V. Phone/Fax

Practice location:
  • Phone: 512-794-8863
  • Fax: 512-795-0688
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number1198840
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: