Provider Demographics
NPI:1467220756
Name:MCCLURE, JOHN REED
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:REED
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17040 GOLFSIDE CIR APT 805
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5024
Mailing Address - Country:US
Mailing Address - Phone:304-688-5155
Mailing Address - Fax:
Practice Address - Street 1:6900 DANIELS PKWY STE 36
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-1587
Practice Address - Country:US
Practice Address - Phone:239-936-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist