Healthcare Provider Details

I. General information

NPI: 1164684288
Provider Name (Legal Business Name): MICHELLE LEIGH FRITZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SE MARICAMP RD
OCALA FL
34471-5582
US

IV. Provider business mailing address

3 TROPICAL PARK RD
OCALA FL
34482-6627
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-8883
  • Fax: 352-351-4219
Mailing address:
  • Phone: 352-390-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA21000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: