Provider Demographics
NPI:1063306066
Name:LONG, ANDREW LELAND (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LELAND
Last Name:LONG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 RED HAWK CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78739-5640
Mailing Address - Country:US
Mailing Address - Phone:303-886-3029
Mailing Address - Fax:
Practice Address - Street 1:12101 BEE CAVES RD STE 5E
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-6464
Practice Address - Country:US
Practice Address - Phone:512-450-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3134366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist