Healthcare Provider Details

I. General information

NPI: 1043793623
Provider Name (Legal Business Name): ELIZABETH BRETFELEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2018
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 TOM ADAMS DR
AUSTIN TX
78753-3354
US

IV. Provider business mailing address

2613 CREEPING VINE CT
PFLUGERVILLE TX
78660-3178
US

V. Phone/Fax

Practice location:
  • Phone: 512-836-1515
  • Fax:
Mailing address:
  • Phone: 512-586-4470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2096851
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: