Provider Demographics
NPI:1255546719
Name:MCLEOD, LORI ANN (PT)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:MCLEOD
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 1:6544 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1427
Mailing Address - Country:US
Mailing Address - Phone:602-405-4535
Mailing Address - Fax:602-678-3218
Practice Address - Street 1:6544 N 13TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1427
Practice Address - Country:US
Practice Address - Phone:602-405-4535
Practice Address - Fax:602-678-3218
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist