Provider Demographics
NPI:1558540369
Name:PANTAGES, ELIZABETH A
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:PANTAGES
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 1:2801 SW COLLEGE RD
Mailing Address - Street 2:SUITE #24
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7406
Mailing Address - Country:US
Mailing Address - Phone:352-873-7555
Mailing Address - Fax:352-873-7556
Practice Address - Street 1:2801 SW COLLEGE RD
Practice Address - Street 2:SUITE #24
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7406
Practice Address - Country:US
Practice Address - Phone:352-873-7555
Practice Address - Fax:352-873-7556
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7022OtherMEDICARE PROVIDER NUMBER