Provider Demographics
NPI:1497735625
Name:MCLEAN, TONYA NOELLE (MPT)
Entity Type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:NOELLE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-2101
Mailing Address - Country:US
Mailing Address - Phone:727-384-4600
Mailing Address - Fax:727-384-4601
Practice Address - Street 1:401 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-2101
Practice Address - Country:US
Practice Address - Phone:727-384-4600
Practice Address - Fax:727-384-4601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist