Provider Demographics
NPI:1952652638
Name:MCLEAN, KAREN LESLEY (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LESLEY
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9331
Mailing Address - Country:US
Mailing Address - Phone:231-409-8758
Mailing Address - Fax:
Practice Address - Street 1:4211 WESTRIDGE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9331
Practice Address - Country:US
Practice Address - Phone:231-409-8758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist