Provider Demographics
NPI:1467683664
Name:MCLEAN, TERRA JO (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TERRA
Middle Name:JO
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 WEXFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2891
Mailing Address - Country:US
Mailing Address - Phone:330-322-4459
Mailing Address - Fax:330-673-1813
Practice Address - Street 1:602 TOURNAMENT DR
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-2284
Practice Address - Country:US
Practice Address - Phone:330-322-4459
Practice Address - Fax:330-673-1813
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4810225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant