Provider Demographics
NPI:1689379349
Name:MCCLUNG, BROOKE WHITNEY (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:WHITNEY
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:866-370-8206
Mailing Address - Fax:517-435-3670
Practice Address - Street 1:7767 SE DOWNING RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MO
Practice Address - Zip Code:64048-8207
Practice Address - Country:US
Practice Address - Phone:816-837-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP026693T225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist