Provider Demographics
NPI:1295007581
Name:MCCLELLAN, MONA RENEE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MONA
Middle Name:RENEE
Last Name:MCCLELLAN
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 1:2625 FOXPOINTE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3278
Mailing Address - Country:US
Mailing Address - Phone:812-314-2378
Mailing Address - Fax:812-373-7616
Practice Address - Street 1:2625 FOXPOINTE DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3278
Practice Address - Country:US
Practice Address - Phone:812-314-2378
Practice Address - Fax:812-373-7616
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017977225100000X
IN05002806A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist