Provider Demographics
NPI:1619974649
Name:MCLEAN, TINA ELAINE (PT, ATC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:ELAINE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:AK
Mailing Address - Zip Code:99672-1118
Mailing Address - Country:US
Mailing Address - Phone:907-262-7748
Mailing Address - Fax:907-262-7749
Practice Address - Street 1:33455 STERLING HIGHWAY
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:AK
Practice Address - Zip Code:99672
Practice Address - Country:US
Practice Address - Phone:907-262-7748
Practice Address - Fax:907-262-7749
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK833225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1029837Medicaid
K162380Medicare PIN