Provider Demographics
NPI:1255423943
Name:MCLEOD, CAMILLE SIMONE (PT)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:SIMONE
Last Name:MCLEOD
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 1:1465 GENE ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4815
Mailing Address - Country:US
Mailing Address - Phone:407-493-5671
Mailing Address - Fax:407-282-8742
Practice Address - Street 1:1465 GENE ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4815
Practice Address - Country:US
Practice Address - Phone:407-493-5671
Practice Address - Fax:407-282-8742
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FLPT19812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886829800Medicaid