Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | S0237 | TX |
NPI | 1003201005 |
---|---|
Provider Name | Elise Tran |
First Address | Southlake, TX 76092-6465 |
Second Address | Southlake, TX 76092-6465 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2015 |
Last Update Date | 20/08/2019 |