Individual
MAX MCLEOD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1220 BERARD ST, SUITE B, BREAUX BRIDGE, LA 70517-4865
(337) 332-6120
Mailing address
PO BOX 875, BREAUX BRIDGE, LA 70517-0875
(337) 332-6120
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0170
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11836051
CIGNA
LA
01
—
6500128565 E0303
RAILROAD MEDICARE
LA
01
—
70517 A002
CHAMPUS
LA
01
—
B4436
BLUE CROS/BLUE SHIELD OF
LA
Enumeration date
03/20/2006
Last updated
07/08/2007
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