Provider Demographics
NPI:1265642649
Name:CAMERON, ELIZABETH OLIVE (PT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OLIVE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-0237
Mailing Address - Country:US
Mailing Address - Phone:817-594-9200
Mailing Address - Fax:817-594-9202
Practice Address - Street 1:100 E HUBBARD ST STE 101
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-5320
Practice Address - Country:US
Practice Address - Phone:940-412-9200
Practice Address - Fax:817-594-9202
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3506225100000X
TX1311392225100000X
NC2589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist