Healthcare Provider Details

I. General information

NPI: 1922298629
Provider Name (Legal Business Name): VALERIE MCLEOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2007
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70A NE MEDICAL CENTER RD
BELFAIR WA
98528-8334
US

IV. Provider business mailing address

PO BOX 637
BELFAIR WA
98528-0637
US

V. Phone/Fax

Practice location:
  • Phone: 360-275-4352
  • Fax: 360-275-5692
Mailing address:
  • Phone: 360-275-4352
  • Fax: 360-275-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT8573
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT00002351
License Number StateWA

VIII. Authorized Official

Name: MS. VALERIE MARGARET MCLEOD
Title or Position: SOLE PROPRIETOR/PHYSICAL THERAPIST
Credential: P.T.
Phone: 360-275-4352