Provider Demographics
NPI:1578969713
Name:MCCLURG, PATRICIA (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MCCLURG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S SARAH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1741
Mailing Address - Country:US
Mailing Address - Phone:918-625-4139
Mailing Address - Fax:
Practice Address - Street 1:13610 BARRETT OFFICE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-7816
Practice Address - Country:US
Practice Address - Phone:314-822-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013018938225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant