Individual
GLENN MACLEAN-TALBOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1020 SW INDIAN AVE STE 102, REDMOND, OR 97756-3037
(541) 504-5363
(541) 504-7677
Mailing address
1020 SW INDIAN AVE STE 102, REDMOND, OR 97756-3037
(541) 504-5363
(541) 504-7677
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
3177
ME
225100000X
Physical Therapist
Primary
5749
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5749
PHYSICAL THERAPY LICENSE NUMBER
OR
Enumeration date
08/19/2006
Last updated
11/13/2012
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