Provider Demographics
NPI:1063019008
Name:MCCLAIN, MEGAN BROOKE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:BROOKE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:BROOKE
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 DALTON LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:AR
Mailing Address - Zip Code:72562-9400
Mailing Address - Country:US
Mailing Address - Phone:870-613-8866
Mailing Address - Fax:
Practice Address - Street 1:240 DALTON LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:AR
Practice Address - Zip Code:72562-9400
Practice Address - Country:US
Practice Address - Phone:870-307-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4553225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant