Provider Demographics
NPI:1013394881
Name:MCLAIN, MICHAEL (MPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCLAIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2288 AUBURN BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-1618
Mailing Address - Country:US
Mailing Address - Phone:916-446-1497
Mailing Address - Fax:916-446-5959
Practice Address - Street 1:2600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-6448
Practice Address - Country:US
Practice Address - Phone:916-782-2761
Practice Address - Fax:916-751-2430
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT42472225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT42472OtherCALIFORNIA PT LICENSE BOARD