1922298629 NPI number — VALERIE MCLEOD

Table of content: (NPI 1922298629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922298629 NPI number — VALERIE MCLEOD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALERIE MCLEOD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922298629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAIR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98528-0637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-275-4352
Provider Business Mailing Address Fax Number:
360-275-5692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70A NE MEDICAL CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELFAIR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98528-8334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-275-4352
Provider Business Practice Location Address Fax Number:
360-275-5692
Provider Enumeration Date:
07/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEOD
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
MARGARET
Authorized Official Title or Position:
SOLE PROPRIETOR/PHYSICAL THERAPIST
Authorized Official Telephone Number:
360-275-4352

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT8573 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: PT00002351 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022593 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8920647 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 33281 . This is a "PROVIDER STATE L&I (WORKE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 33180 . This is a "FACILITY STATE L&I (WORKE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7014301 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MC2314 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 191984200 . This is a "OWCP FEDERAL L&I (WORKERS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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