Provider Demographics
NPI:1336143197
Name:LECLAIRE, RICHARD P (PT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:P
Last Name:LECLAIRE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FALL RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:SEEKONK
Mailing Address - State:MA
Mailing Address - Zip Code:02771-5506
Mailing Address - Country:US
Mailing Address - Phone:508-336-3121
Mailing Address - Fax:508-336-3120
Practice Address - Street 1:350 FALL RIVER AVE
Practice Address - Street 2:
Practice Address - City:SEEKONK
Practice Address - State:MA
Practice Address - Zip Code:02771-5506
Practice Address - Country:US
Practice Address - Phone:508-336-3121
Practice Address - Fax:508-336-3120
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8100225100000X
RIPT00460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA608183OtherTUFTS
RI402383OtherBLUECHIP
MAY66685OtherBLUE CROSS BLUE SHIELD MA
MA43142951OtherHEALTHCARE VALUE MGMT
RI2520-9OtherBLUE CROSS BLUE SHIELD RI
RI64-00067OtherUNITED HEALTH CARE
RIRL35724Medicaid
MA605708OtherHARVARD PILGRIM
RI2520-9OtherBLUE CROSS BLUE SHIELD RI