Provider Demographics
NPI:1548092372
Name:MCCLURG, DENISE (CPTA)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-0263
Mailing Address - Country:US
Mailing Address - Phone:402-879-1267
Mailing Address - Fax:866-764-0606
Practice Address - Street 1:PO BOX 263
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-0263
Practice Address - Country:US
Practice Address - Phone:402-879-1267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02491225200000X
NE763225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant