Provider Demographics
NPI:1730391780
Name:MCCLURE, REBECCA JO (PT, MOMT)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JO
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PT, MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:108 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-1824
Mailing Address - Country:US
Mailing Address - Phone:785-841-7631
Mailing Address - Fax:
Practice Address - Street 1:3510 CLINTON PL
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-2195
Practice Address - Country:US
Practice Address - Phone:785-840-3780
Practice Address - Fax:785-312-6707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist