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General NPI Number Information
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NPI Number | 1346430915
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Entity Type | Individual
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Provider Name | MRS. RENEE LONG
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 1934 HICKORY ST
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City | ABILENE
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State | TX
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Zip | 79601-2336
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Country | US
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Telephone | 325-670-6061
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Fax |
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Provider Business Mailing Address
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Address Line | 3941 RIDGWAY CIR
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City | ABILENE
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State | TX
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Zip | 79606-2632
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Country | US
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Telephone | 325-690-9198
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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 | 1099182
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 1099182
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License Number State | TX
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