Provider Demographics
NPI:1780060095
Name:MCLELLAN, BRIAN S (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:MCLELLAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3023
Mailing Address - Country:US
Mailing Address - Phone:860-930-9421
Mailing Address - Fax:
Practice Address - Street 1:30 LOEFFLER RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2256
Practice Address - Country:US
Practice Address - Phone:860-380-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10599225100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist