Provider Demographics
NPI:1225072788
Name:MCCLAY, VICKIE MARIE (PT)
Entity Type:Individual
Prefix:
First Name:VICKIE
Middle Name:MARIE
Last Name:MCCLAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICKIE
Other - Middle Name:MARIE
Other - Last Name:FORTSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5789 DAGGETT RD
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-8883
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4800 BIRCHDALE DR
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:PA
Practice Address - Zip Code:16417-1822
Practice Address - Country:US
Practice Address - Phone:814-774-2035
Practice Address - Fax:814-774-9607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008617L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist