Provider Demographics
NPI:1588661128
Name:MCCLAIN, KATHERINE ELAINE (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:ELAINE
Last Name:MCCLAIN
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 1:5501 N ORACLE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-3850
Mailing Address - Country:US
Mailing Address - Phone:520-293-5551
Mailing Address - Fax:520-293-6638
Practice Address - Street 1:5501 N ORACLE RD
Practice Address - Street 2:STE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3850
Practice Address - Country:US
Practice Address - Phone:520-293-5551
Practice Address - Fax:520-293-6638
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2820225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86059251885704C012OtherTRICARE
AZ650023269Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZ68129Medicare ID - Type UnspecifiedMEDICARE