Provider Demographics
NPI:1013186899
Name:MCLAIN, MAUREEN (PT)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 OVERLOOK TER
Mailing Address - Street 2:PMRS
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2254
Mailing Address - Country:US
Mailing Address - Phone:608-256-1901
Mailing Address - Fax:608-280-7079
Practice Address - Street 1:2500 OVERLOOK TER
Practice Address - Street 2:PMRS
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2254
Practice Address - Country:US
Practice Address - Phone:608-256-1901
Practice Address - Fax:608-280-7079
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist