Provider Demographics
NPI:1144389255
Name:MCCLANAHAN, DAN EVAN (PT)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:EVAN
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-293-6262
Mailing Address - Fax:505-293-6622
Practice Address - Street 1:9201 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 302
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-293-6262
Practice Address - Fax:505-293-6622
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist