Provider Demographics
NPI:1902921968
Name:CLEASBY, ELIZABETH MARY (PTLA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARY
Last Name:CLEASBY
Suffix:
Gender:F
Credentials:PTLA
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:MARY
Other - Last Name:KILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051
Mailing Address - Country:US
Mailing Address - Phone:603-598-0729
Mailing Address - Fax:603-598-0864
Practice Address - Street 1:5 GEORGE ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NH
Practice Address - Zip Code:03051
Practice Address - Country:US
Practice Address - Phone:603-598-0729
Practice Address - Fax:603-598-0864
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist