Healthcare Provider Details

I. General information

NPI: 1801718960
Provider Name (Legal Business Name): HALEY MARIE MCLELLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 GRAND POINTE CT
GRAND BLANC MI
48439-5502
US

IV. Provider business mailing address

1071 CABOT DR
FLINT MI
48532-2679
US

V. Phone/Fax

Practice location:
  • Phone: 810-695-8920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502009048
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: