Healthcare Provider Details

I. General information

NPI: 1902479652
Provider Name (Legal Business Name): ELIZABETH ESPINOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12501 LONGHORN PKWY
AUSTIN TX
78732-1267
US

IV. Provider business mailing address

12430 METRIC BLVD APT 10310
AUSTIN TX
78758-5575
US

V. Phone/Fax

Practice location:
  • Phone: 512-266-5600
  • Fax:
Mailing address:
  • Phone: 512-299-7302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2090116
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: