Healthcare Provider Details

I. General information

NPI: 1609805803
Provider Name (Legal Business Name): KAREN EILEEN MCCLELLAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HALL ST SUITE 201 PROFESSIONAL PHYSICAL THERAPY SERVICES LLC
CONCORD NH
03301-3471
US

IV. Provider business mailing address

25 HALL ST SUITE 201 PROFESSIONAL PHYSICAL THERAPY SERVICES LLC
CONCORD NH
03301-3471
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-3500
  • Fax: 603-226-3420
Mailing address:
  • Phone: 603-226-3500
  • Fax: 603-226-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1052
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: