Provider Demographics
NPI:1376678821
Name:MCCLUNE, DONALD LYLE (MPT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LYLE
Last Name:MCCLUNE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 N ARBOR TER
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4362
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18 N WORTHEN ST
Practice Address - Street 2:STE 200
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-6137
Practice Address - Country:US
Practice Address - Phone:509-665-3156
Practice Address - Fax:509-665-0414
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006546225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0186423OtherLABOR & INDUSTRIES
WA8803969Medicare ID - Type Unspecified