MEDICARE: MARY ELIZABETH VAN CLEAVE 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	225100000X	Physical Therapist	1255306	TX

General Provider Information

NPI Number	:	1295127066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH VAN CLEAVE PT, DPT

Provider Business Mailing Address
First Line	:	2035 FORT WORTH HWY
Second Line	:	SUITE 300
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4782
Country	:	US
Telephone Number	:	817-599-9271
Fax Number	:	817-599-9295

Provider Business Practice Location Address
First Line	:	2035 FORT WORTH HWY
Second Line	:	SUITE 300
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4782
Country	:	US
Telephone Number	:	817-599-9271
Fax Number	:	817-599-9295

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

Provider Enumeration Date	:	03/03/2015
Last Update Date	:	03/03/2015

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