Healthcare Provider Details

I. General information

NPI: 1326344250
Provider Name (Legal Business Name): LEESA MARIE MCLAUGHLIN LEESA MCLAUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEESA MCLAUGHLIN LEESA MCLAUGHLIN

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 02/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 PARKINGWAY
QUINCY MA
02169-5020
US

IV. Provider business mailing address

26 VINCENT ST
WHITMAN MA
02382-2221
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-4222
  • Fax:
Mailing address:
  • Phone: 617-291-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7612
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: