Provider Demographics
NPI:1003160896
Name:MCCLONE, NICOLE ALYSON (DPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALYSON
Last Name:MCCLONE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6800 SOUTHPOINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8203
Mailing Address - Country:US
Mailing Address - Phone:904-634-0640
Mailing Address - Fax:046-340-2039
Practice Address - Street 1:3055 COUNTY ROAD 210 W STE 110
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:904-825-0540
Practice Address - Fax:904-825-2490
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27401207QS0010X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine