Provider Demographics
NPI:1447297262
Name:MACLEOD, TANYA LEIGH (PT, DPT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LEIGH
Last Name:MACLEOD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 7TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2779
Mailing Address - Country:US
Mailing Address - Phone:310-663-5546
Mailing Address - Fax:
Practice Address - Street 1:10585 SANTA MONICA BLVD
Practice Address - Street 2:SUITE #100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4921
Practice Address - Country:US
Practice Address - Phone:310-663-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT327632251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT32763OtherSTATE LICENSE NUMBER