Healthcare Provider Details

I. General information

NPI: 1558926212
Provider Name (Legal Business Name): SARAH E MCLEAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH E BULL PT

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

IV. Provider business mailing address

11 PARTRIDGE LN
KENNEBUNK ME
04043-6848
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-6977
  • Fax:
Mailing address:
  • Phone: 603-387-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3242
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1660
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: