Provider Demographics
NPI:1366495053
Name:MCGREGOR, MARY ELIZABETH (DPT, OCS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MCGREGOR
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1821 WILSHIRE BLVD
Mailing Address - Street 2:#610
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5618
Mailing Address - Country:US
Mailing Address - Phone:310-453-8819
Mailing Address - Fax:310-453-8810
Practice Address - Street 1:1821 WILSHIRE BLVD
Practice Address - Street 2:#610
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5618
Practice Address - Country:US
Practice Address - Phone:310-453-8819
Practice Address - Fax:310-453-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT28750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEI928AOtherMEDICARE PTAN
CAWPT28750BMedicare ID - Type Unspecified