Provider Demographics
NPI:1316546757
Name:MCCLANAHAN, MATHEW (PT)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2828
Mailing Address - Country:US
Mailing Address - Phone:314-973-7464
Mailing Address - Fax:
Practice Address - Street 1:15609 RONALD W REAGAN BLVD BLDG A130
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-1472
Practice Address - Country:US
Practice Address - Phone:512-986-4468
Practice Address - Fax:512-986-7076
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1321866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist