Healthcare Provider Details

I. General information

NPI: 1043077324
Provider Name (Legal Business Name): ELENA LINCOLN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5104 MEYERS LN
FORT WORTH TX
76244-6035
US

IV. Provider business mailing address

5104 MEYERS LN
FORT WORTH TX
76244-6035
US

V. Phone/Fax

Practice location:
  • Phone: 817-676-5532
  • Fax:
Mailing address:
  • Phone: 817-676-5532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT129769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: