Basic Information
| Provider Information | |||||||||
| NPI: | 1487626958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | IAN | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | PA-C, ATC, NCTMB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15810 S 45TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802223384 | ||||||||
| FaxNumber: | 4802223422 | ||||||||
| Practice Location | |||||||||
| Address1: | 15810 S 45TH ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850487694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802223384 | ||||||||
| FaxNumber: | 4802223422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 10/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 0364 | AZ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 363A00000X | 4246 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.