Healthcare Provider Details

I. General information

NPI: 1912794074
Provider Name (Legal Business Name): RICHARD MCLEOD JR. DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 MALCOLM RD STE 109
CLINTON MD
20735-1734
US

IV. Provider business mailing address

2122 YORK RD STE 300
OAK BROOK IL
60523-1925
US

V. Phone/Fax

Practice location:
  • Phone: 301-856-0050
  • Fax: 301-856-0518
Mailing address:
  • Phone: 570-550-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP046600T
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP23844
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP061977T
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: