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General NPI Number Information
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NPI Number | 1063306066
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Entity Type | Individual
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Provider Name | ANDREW LELAND LONG DPT
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Gender | Male
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 12101 BEE CAVES RD STE 5E
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City | BEE CAVE
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State | TX
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Zip | 78738-6464
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Country | US
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Telephone | 512-450-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 12000 RED HAWK CV
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City | AUSTIN
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State | TX
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Zip | 78739-5640
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Country | US
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Telephone | 303-886-3029
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3134366
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License Number State | TX
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