Provider Demographics
NPI:1922298629
Name:VALERIE MCLEOD
Entity Type:Organization
Organization Name:VALERIE MCLEOD
Other - Org Name:MCLEOD PHYSICAL THERAPY/MASON THURSTON PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SOLE PROPRIETOR/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:MCLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-275-4352
Mailing Address - Street 1:PO BOX 637
Mailing Address - Street 2:
Mailing Address - City:BELFAIR
Mailing Address - State:WA
Mailing Address - Zip Code:98528-0637
Mailing Address - Country:US
Mailing Address - Phone:360-275-4352
Mailing Address - Fax:360-275-5692
Practice Address - Street 1:70A NE MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-8334
Practice Address - Country:US
Practice Address - Phone:360-275-4352
Practice Address - Fax:360-275-5692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002351261QP2000X
CAPT8573261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR022593Medicaid
WA8920647OtherCRIME VICTIMS
WA33281OtherPROVIDER STATE L&I (WORKE
WA33180OtherFACILITY STATE L&I (WORKE
WA7014301Medicaid
WAMC2314OtherREGENCE BLUE SHIELD
WA191984200OtherOWCP FEDERAL L&I (WORKERS
WA8920647OtherCRIME VICTIMS
OR022593Medicaid