Provider Demographics
NPI:1487775474
Name:MCLEAN, JOANNE MARIE (PT)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:MCLEAN
Other - Last Name:LATOSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:MEREDITH
Mailing Address - State:NH
Mailing Address - Zip Code:03253
Mailing Address - Country:US
Mailing Address - Phone:603-398-3180
Mailing Address - Fax:
Practice Address - Street 1:28 COMMERCE STREET
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-225-5132
Practice Address - Fax:603-225-6061
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0444208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation