Individual
BRENT MATTHEW MCLEOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T
Contact information
Practice address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Mailing address
700 DEBORAH RD, STE 190, NEWBERG, OR 97132-3075
(503) 662-6403
(503) 395-1911
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6051
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0254307
WASHINGTON L&I
OR
05
—
500618581
—
OR
01
—
P01216092
RR MEDICARE
OR
Enumeration date
09/18/2009
Last updated
01/20/2020
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