Provider Demographics
NPI:1396795423
Name:MCFADDEN, LEE R (MS, PT, PCS)
Entity type:Individual
Prefix:MRS
First Name:LEE
Middle Name:R
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:MS, PT, PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 PENNWOOD PL
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-8505
Mailing Address - Country:US
Mailing Address - Phone:860-589-0097
Mailing Address - Fax:
Practice Address - Street 1:305 PENNWOOD PL
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-8505
Practice Address - Country:US
Practice Address - Phone:860-589-0097
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0025692251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics