Provider Demographics
NPI:1508070426
Name:MCCLURE, SARA (PT)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:MCCLURE
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 1:16 POOLE RD
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-3741
Mailing Address - Country:US
Mailing Address - Phone:207-377-9400
Mailing Address - Fax:207-377-3385
Practice Address - Street 1:18A HIGH STREET
Practice Address - Street 2:
Practice Address - City:WINTRHOP
Practice Address - State:ME
Practice Address - Zip Code:04364
Practice Address - Country:US
Practice Address - Phone:207-377-9400
Practice Address - Fax:207-377-3385
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPT2095OtherLISCENSE