Provider Demographics
NPI:1437400199
Name:MCCLANAHAN, DESIREE RENAE (DPT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:RENAE
Last Name:MCCLANAHAN
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 1:1653 CANTEBURY LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8680
Mailing Address - Country:US
Mailing Address - Phone:812-584-7795
Mailing Address - Fax:
Practice Address - Street 1:6281 TRI RIDGE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-8345
Practice Address - Country:US
Practice Address - Phone:866-791-5766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH012743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist