Provider Demographics
NPI:1801628763
Name:MCGILL, ELIZABETH FAITH (PTA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FAITH
Last Name:MCGILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:FAITH
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:25700 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5809
Mailing Address - Country:US
Mailing Address - Phone:248-415-2500
Mailing Address - Fax:
Practice Address - Street 1:25700 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5809
Practice Address - Country:US
Practice Address - Phone:248-415-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502008569225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant