Basic Information
| Provider Information | |||||||||
| NPI: | 1710222740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLUSKIE | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | LAMBERT | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 CENTERVILLE RD 1 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4013846490 | ||||||||
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| Practice Location | |||||||||
| Address1: | 535 CENTERVILLE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028864486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017374581 | ||||||||
| FaxNumber: | 4017374811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2012 | ||||||||
| LastUpdateDate: | 10/20/2015 | ||||||||
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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 | 225100000X | PT02539 | RI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.