Provider Demographics
NPI:1629151063
Name:MCLEAN, LORI DENISE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:DENISE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:DENISE
Other - Last Name:CUCUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:39930 SIERRA WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-8304
Mailing Address - Country:US
Mailing Address - Phone:559-683-0974
Mailing Address - Fax:559-683-0973
Practice Address - Street 1:39930 SIERRA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644
Practice Address - Country:US
Practice Address - Phone:559-683-0974
Practice Address - Fax:559-683-0973
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT13880OtherPT BOARD OF CA
CA0PT138801Medicare PIN