Provider Demographics
NPI:1235473844
Name:MCCLELLAN, MAAYAN GELLER (DPT)
Entity Type:Individual
Prefix:
First Name:MAAYAN
Middle Name:GELLER
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S DE ANZA BLVD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-5347
Mailing Address - Country:US
Mailing Address - Phone:408-257-2225
Mailing Address - Fax:
Practice Address - Street 1:1601 S DE ANZA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5347
Practice Address - Country:US
Practice Address - Phone:408-257-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist