Provider Demographics
NPI:1609805803
Name:MCCLELLAN, KAREN EILEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:EILEEN
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:25 HALL ST
Mailing Address - Street 2:SUITE 201 PROFESSIONAL PHYSICAL THERAPY SERVICES LLC
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3471
Mailing Address - Country:US
Mailing Address - Phone:603-226-3500
Mailing Address - Fax:603-226-3420
Practice Address - Street 1:25 HALL ST
Practice Address - Street 2:SUITE 201 PROFESSIONAL PHYSICAL THERAPY SERVICES LLC
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3471
Practice Address - Country:US
Practice Address - Phone:603-226-3500
Practice Address - Fax:603-226-3420
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH1052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30391188Medicaid
NH08Y002723NH01OtherBLUE CROSS
NHNA1218OtherHARVARD PILGRIM
NH08Y002723NH01OtherBLUE CROSS