Provider Demographics
NPI:1225074297
Name:MCLENDON, CATHY L (PT)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:M
Other - Last Name:WISDOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 ANSLEY DR
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1613
Mailing Address - Country:US
Mailing Address - Phone:706-864-0755
Mailing Address - Fax:706-864-0987
Practice Address - Street 1:111 TIPTON DR
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-1604
Practice Address - Country:US
Practice Address - Phone:706-864-0755
Practice Address - Fax:706-864-0987
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001578225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I650304OtherMEDICARE PTAN
GA454066516AMedicaid