Provider Demographics
NPI:1629330279
Name:MCCLATCHIE, LOIS G
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:G
Last Name:MCCLATCHIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PLEASANT AVENUE
Mailing Address - Street 2:ST. JOSEPH'S AREA HEALTH SERVICES
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470
Mailing Address - Country:US
Mailing Address - Phone:218-237-5496
Mailing Address - Fax:218-237-5702
Practice Address - Street 1:600 PLEASANT AVENUE
Practice Address - Street 2:ST. JOSEPH'S AREA HEALTH SERVICES
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470
Practice Address - Country:US
Practice Address - Phone:218-237-5496
Practice Address - Fax:218-237-5702
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN870225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist