Healthcare Provider Details

I. General information

NPI: 1487775474
Provider Name (Legal Business Name): JOANNE MARIE MCLEAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNE MCLEAN LATOSEK PT

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 COMMERCE STREET
CONCORD NH
03301
US

IV. Provider business mailing address

PO BOX 962
MEREDITH NH
03253
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-5132
  • Fax: 603-225-6061
Mailing address:
  • Phone: 603-398-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0444
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: