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General NPI Number Information
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NPI Number | 1669676599
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Entity Type | Organization
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Legal Business Name | MCLEAN HEALTH CENTER
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 75 GREAT POND RD
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City | SIMSBURY
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State | CT
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Zip | 06070-1980
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Country | US
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Telephone | 860-651-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 131 GREAT POND RD
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City | SIMSBURY
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State | CT
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Zip | 06070-1525
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Country | US
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Telephone | 860-651-7214
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. MARY C. GIBBONS
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Credential | BS , RPT
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Telephone | 860-658-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 004091
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License Number State | CT
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