Healthcare Provider Details

I. General information

NPI: 1629444617
Provider Name (Legal Business Name): ELISE BJORK PT, DPT, CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELISE BJORK

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 WESTBANK DR. STE. 210
WESTLAKE HILLS TX
78746-6771
US

IV. Provider business mailing address

8505 N CAPITAL OF TEXAS HWY APT. 1010
AUSTIN TX
78759-8447
US

V. Phone/Fax

Practice location:
  • Phone: 512-306-8071
  • Fax:
Mailing address:
  • Phone: 512-680-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1263016
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: