Healthcare Provider Details

I. General information

NPI: 1689510406
Provider Name (Legal Business Name): ELISABETH STEPHANIE MCCALL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 NE 5TH PL
GAINESVILLE FL
32601-5657
US

IV. Provider business mailing address

1118 NE 5TH PL
GAINESVILLE FL
32601-5657
US

V. Phone/Fax

Practice location:
  • Phone: 352-281-5953
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA41808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: