Individual
MS. ELIZABETH HALL EDMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
113 NE JOHNSON AVE, SUITE 100, BURLESON, TX 76028-4124
(817) 447-2323
(817) 447-3311
Mailing address
113 NE JOHNSON AVE, SUITE 100, BURLESON, TX 76028-4138
(817) 447-2323
(817) 447-3311
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1115673
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036770801
—
TX
01
—
8T4767
BCBS PROVIDER #
TX
Enumeration date
08/15/2005
Last updated
03/16/2011
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