Provider Demographics
NPI:1730163718
Name:MCCLARY, JENNA LYNN (PT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNN
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:PT
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 5629
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5629
Mailing Address - Country:US
Mailing Address - Phone:502-882-9379
Mailing Address - Fax:502-805-0526
Practice Address - Street 1:75 INDUSTRIAL PARK RD STE D
Practice Address - Street 2:
Practice Address - City:FERDINAND
Practice Address - State:IN
Practice Address - Zip Code:47532-9667
Practice Address - Country:US
Practice Address - Phone:502-882-9379
Practice Address - Fax:502-805-0526
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05004123A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818580Medicaid
IN00000092824OtherBLUE CROSS BLUE SHIELD
IN255480MMedicare PIN
IN216070UMedicare PIN