Provider Demographics
NPI:1689863573
Name:MCLEAN, LORI E (LMT)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:E
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 HARVARDSTON LOOP
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-1029
Mailing Address - Country:US
Mailing Address - Phone:727-271-1600
Mailing Address - Fax:
Practice Address - Street 1:3125 HARVARDSTON LOOP
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-1029
Practice Address - Country:US
Practice Address - Phone:727-271-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist