Provider Demographics
NPI:1710228176
Name:MCCLURE, ERIN K (PTA)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:K
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:K
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3743 MCKOON AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305-1909
Mailing Address - Country:US
Mailing Address - Phone:716-285-8380
Mailing Address - Fax:
Practice Address - Street 1:1200 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-517-2369
Practice Address - Fax:716-517-3738
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002669-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant