Provider Demographics
NPI:1770777641
Name:MCAULIFFE, LIBIA N (PTA)
Entity type:Individual
Prefix:MRS
First Name:LIBIA
Middle Name:N
Last Name:MCAULIFFE
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 1:27 TOURAINE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-1957
Mailing Address - Country:US
Mailing Address - Phone:508-394-3924
Mailing Address - Fax:
Practice Address - Street 1:27 TOURAINE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-1957
Practice Address - Country:US
Practice Address - Phone:508-394-3924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3180225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant