Provider Demographics
NPI:1285672311
Name:MCCLURE, JENNIFER RAE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RAE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38042 CABIN TRL
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-8600
Mailing Address - Country:US
Mailing Address - Phone:405-275-7897
Mailing Address - Fax:405-598-2833
Practice Address - Street 1:1011 N BROADWAY ST
Practice Address - Street 2:SUITE 6
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873-1431
Practice Address - Country:US
Practice Address - Phone:405-598-2899
Practice Address - Fax:405-598-2833
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist