Healthcare Provider Details

I. General information

NPI: 1629146956
Provider Name (Legal Business Name): MARIE ELLEN MACLEOD P.T., M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 ALDER LN
BURLINGTON VT
05401-4902
US

IV. Provider business mailing address

28 ALDER LN
BURLINGTON VT
05401-4902
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-0299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040-0003285
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number0040-0003285
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: