Provider Demographics
NPI:1629754809
Name:MCLEAN, KRISTIN ELLEN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELLEN
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ELLEN
Other - Last Name:ROGACKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1487 BEAUSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3326
Mailing Address - Country:US
Mailing Address - Phone:937-689-1989
Mailing Address - Fax:
Practice Address - Street 1:7677 YANKEE ST STE 210
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3475
Practice Address - Country:US
Practice Address - Phone:937-401-6109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.014897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist