Provider Demographics
NPI:1457497349
Name:MCLENDON, TONYA G (PT)
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:G
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 CRYSTAL HILL LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-4400
Mailing Address - Country:US
Mailing Address - Phone:601-892-8707
Mailing Address - Fax:601-892-7614
Practice Address - Street 1:102 W RAILROAD AVE N
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2154
Practice Address - Country:US
Practice Address - Phone:601-892-8707
Practice Address - Fax:601-892-7614
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist