MEDICARE: ELIZABETH EDWARDS

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	1407272	TX

General Provider Information

NPI Number	:	1730018342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH EDWARDS

Provider Business Mailing Address
First Line	:	38126 MONTICELLO DR
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-4148
Country	:	US
Telephone Number	:	225-993-1436
Fax Number	:

Provider Business Practice Location Address
First Line	:	16811 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-4728
Country	:	US
Telephone Number	:	281-275-0450
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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