Provider Demographics
NPI:1174830111
Name:MCCLARY, KAREN E (PT)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:E
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 S. LOCUST ST
Mailing Address - Street 2:STE 5
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5789
Mailing Address - Country:US
Mailing Address - Phone:575-521-4188
Mailing Address - Fax:575-521-3668
Practice Address - Street 1:2205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3113
Practice Address - Country:US
Practice Address - Phone:575-652-3515
Practice Address - Fax:575-652-3518
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60185600225100000X
NM4149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA03339MCOtherREGENCE
WA0333MCOtherREGENCE
WA0334MCOtherREGENCE
WA1174830111OtherDSHS
WA0270986OtherDEPT OF L&I
WA0336MCOtherREGENCE
WA0270990OtherDEPT OF L&I
WA0270993OtherDEPT OF L&I
WA0341MCOtherREGENCE
WAP00893794OtherRAILROAD MEDICARE
WA0332MCOtherREGENCE
WA0335MCOtherREGENCE
WA0271004OtherDEPT OF L&I
WA0338MCOtherREGENCE
WA0340MCOtherREGENCE
WA0335MCOtherREGENCE
WA0340MCOtherREGENCE
WA0338MCOtherREGENCE