Provider Demographics
NPI:1295127066
Name:VAN CLEAVE, MARY ELIZABETH (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:VAN CLEAVE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 FORT WORTH HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-4782
Mailing Address - Country:US
Mailing Address - Phone:817-599-9271
Mailing Address - Fax:817-599-9295
Practice Address - Street 1:2035 FORT WORTH HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-4782
Practice Address - Country:US
Practice Address - Phone:817-599-9271
Practice Address - Fax:817-599-9295
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1255306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist