Provider Demographics
NPI:1508907601
Name:LECLAIR, HELEN SUE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:SUE
Last Name:LECLAIR
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 1:3057 W WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-7616
Mailing Address - Country:US
Mailing Address - Phone:520-586-3069
Mailing Address - Fax:
Practice Address - Street 1:3057 W WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-7616
Practice Address - Country:US
Practice Address - Phone:520-586-3069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ775314Medicaid