MEDICARE: MRS. RENEAU LYNN ELSWORTH PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1090892	TX

General Provider Information

NPI Number	:	1144468752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENEAU LYNN ELSWORTH PT

Provider Business Mailing Address
First Line	:	21200 STATE HIGHWAY 46 W
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6793
Country	:	US
Telephone Number	:	830-980-4055
Fax Number	:	830-438-4085

Provider Business Practice Location Address
First Line	:	21200 STATE HIGHWAY 46 W
Second Line	:
City	:	SPRING BRANCH
State	:	TX
Zip	:	78070-6793
Country	:	US
Telephone Number	:	830-980-4055
Fax Number	:	830-438-4085

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	08/25/2009

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