Provider Demographics
NPI:1881801538
Name:MCLEOD, SHIRLEY JEAN (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-6033
Mailing Address - Country:US
Mailing Address - Phone:127-035-4857
Mailing Address - Fax:
Practice Address - Street 1:716 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2546
Practice Address - Country:US
Practice Address - Phone:127-076-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA000558225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant