Healthcare Provider Details

I. General information

NPI: 1447297262
Provider Name (Legal Business Name): TANYA LEIGH MACLEOD PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10585 SANTA MONICA BLVD SUITE #100
LOS ANGELES CA
90025-4921
US

IV. Provider business mailing address

911 7TH ST SUITE D
SANTA MONICA CA
90403-2779
US

V. Phone/Fax

Practice location:
  • Phone: 310-663-5546
  • Fax:
Mailing address:
  • Phone: 310-663-5546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT32763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: