Provider Demographics
NPI:1710222740
Name:MCCLUSKIE, SEAN LAMBERT (PT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:LAMBERT
Last Name:MCCLUSKIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CENTERVILLE RD 1
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4400
Mailing Address - Country:US
Mailing Address - Phone:401-384-6490
Mailing Address - Fax:
Practice Address - Street 1:535 CENTERVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4486
Practice Address - Country:US
Practice Address - Phone:401-737-4581
Practice Address - Fax:401-737-4811
Is Sole Proprietor?:No
Enumeration Date:2012-12-03
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02539225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist