Provider Demographics
NPI:1518942697
Name:MCCLENAHAN, KEVIN (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCCLENAHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16615 LARK AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-7645
Mailing Address - Country:US
Mailing Address - Phone:408-358-1460
Mailing Address - Fax:408-358-1459
Practice Address - Street 1:16615 LARK AVE
Practice Address - Street 2:STE 101
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-7645
Practice Address - Country:US
Practice Address - Phone:408-358-1460
Practice Address - Fax:408-358-1459
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26663225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26663AMedicare PIN