Individual
ELIZABETH RENEE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
18404 LAKELAND DR, LAGO VISTA, TX 78645-8702
(512) 639-7505
Mailing address
18404 LAKELAND DR, LAGO VISTA, TX 78645-8702
(512) 639-7505
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT134826
TX
Other
Enumeration date
06/22/2021
Last updated
06/22/2021
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