Healthcare Provider Details

I. General information

NPI: 1659929255
Provider Name (Legal Business Name): ELIZABETH MARIE MCKENNA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

25031 BUTTERMILK LN
SAN ANTONIO TX
78255-2335
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax:
Mailing address:
  • Phone: 361-492-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1323586
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1323586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: