Provider Demographics
NPI:1598040123
Name:MCCAULEY, JEAN-MARIE ANTOINETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:JEAN-MARIE
Middle Name:ANTOINETTE
Last Name:MCCAULEY
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 1:880 W PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-4879
Mailing Address - Country:US
Mailing Address - Phone:352-746-9398
Mailing Address - Fax:
Practice Address - Street 1:880 W PEARSON ST
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-4879
Practice Address - Country:US
Practice Address - Phone:352-476-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist