Provider Demographics
NPI:1619355112
Name:HEBERT, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HEBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 W SAINT JOHNS AVE
Mailing Address - Street 2:UNTI 2105
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2387
Mailing Address - Country:US
Mailing Address - Phone:512-900-0900
Mailing Address - Fax:
Practice Address - Street 1:811 W SAINT JOHNS AVE
Practice Address - Street 2:UNTI 2105
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-2387
Practice Address - Country:US
Practice Address - Phone:512-900-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-15
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT104670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist