Provider Demographics
NPI:1144257122
Name:MCLEAN, GEORGE D (PT)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:D
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 FRONT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1559
Mailing Address - Country:US
Mailing Address - Phone:607-754-1776
Mailing Address - Fax:607-748-5465
Practice Address - Street 1:200 FRONT STREET
Practice Address - Street 2:SUITE D
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:607-754-1776
Practice Address - Fax:607-748-5465
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0064311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4343Medicare ID - Type Unspecified