MEDICARE: TANYA LEIGH MACLEOD PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT32763	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT32763	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1447297262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA LEIGH MACLEOD PT, DPT

Provider Business Mailing Address
First Line	:	911 7TH ST
Second Line	:	SUITE D
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-2779
Country	:	US
Telephone Number	:	310-663-5546
Fax Number	:

Provider Business Practice Location Address
First Line	:	10585 SANTA MONICA BLVD
Second Line	:	SUITE #100
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4921
Country	:	US
Telephone Number	:	310-663-5546
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	02/19/2013

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