Provider Demographics
NPI:1457622920
Name:MACLEAN, ELIZABETH LAURIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LAURIE
Last Name:MACLEAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4046 BRAEMERE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-0680
Mailing Address - Country:US
Mailing Address - Phone:352-585-2544
Mailing Address - Fax:
Practice Address - Street 1:4046 BRAEMERE DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-0680
Practice Address - Country:US
Practice Address - Phone:352-585-2544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22647225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant