Provider Demographics
NPI:1063423457
Name:LECLAIRE, DENISE L (PT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:LECLAIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 EAST AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5299
Mailing Address - Country:US
Mailing Address - Phone:401-722-2225
Mailing Address - Fax:401-722-2235
Practice Address - Street 1:407 EAST AVE STE 150
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5299
Practice Address - Country:US
Practice Address - Phone:401-722-2225
Practice Address - Fax:401-722-2235
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT 10850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI06400314OtherUNITED HEALTHCARE
RI2499706OtherAETNA US HEALTHCARE
RI4259OtherNEIGHBORHOOD HEALTH PLAN
RI22211OtherRHODE BLUE CROSS
RI405323OtherRHODE ISLAND BLUECHIP
RI610805800OtherFEDERAL WORKERS COMPENSAT
RI709004027Medicare ID - Type UnspecifiedGROUP NUMBER