Provider Demographics
NPI:1326344250
Name:MCLAUGHLIN, LEESA MARIE (LEESA MCLAUGHLIN)
Entity Type:Individual
Prefix:
First Name:LEESA
Middle Name:MARIE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:LEESA MCLAUGHLIN
Other - Prefix:
Other - First Name:LEESA
Other - Middle Name:
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LEESA MCLAUGHLIN
Mailing Address - Street 1:26 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-2221
Mailing Address - Country:US
Mailing Address - Phone:617-291-2582
Mailing Address - Fax:
Practice Address - Street 1:164 PARKINGWAY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5020
Practice Address - Country:US
Practice Address - Phone:617-773-4222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7612225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant