Provider Demographics
NPI:1386897098
Name:CLEELAND, PATRICIA ANN (LMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:CLEELAND
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14618 CYPRESS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1988
Mailing Address - Country:US
Mailing Address - Phone:713-628-5717
Mailing Address - Fax:
Practice Address - Street 1:14618 CYPRESS VALLEY DR
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-1988
Practice Address - Country:US
Practice Address - Phone:713-628-5717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT105833225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist