MEDICARE: TESSA MCELROY

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1609476894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA MCELROY

Provider Business Mailing Address
First Line	:	1606 TRAIL GLEN CT
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3152
Country	:	US
Telephone Number	:	817-675-0855
Fax Number	:

Provider Business Practice Location Address
First Line	:	1606 TRAIL GLEN CT
Second Line	:
City	:	PANTEGO
State	:	TX
Zip	:	76013-3152
Country	:	US
Telephone Number	:	817-675-0855
Fax Number	:

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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Directions to “ TESSA MCELROY ” Practice Location

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