Provider Demographics
NPI:1144201922
Name:MCLEAN, JIM M (PT,CSCS)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:M
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:PT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:FRENCHTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59834-0767
Mailing Address - Country:US
Mailing Address - Phone:406-626-0026
Mailing Address - Fax:
Practice Address - Street 1:16600 BECKWITH ROAD
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834
Practice Address - Country:US
Practice Address - Phone:406-262-0026
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT61825OtherBCBS
MTMSF0952741OtherMT STATE FUND WORK COMP
MT0348712Medicaid