Provider Demographics
NPI:1720019227
Name:MCLEARY, DAVID WAYNE (MSPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:MCLEARY
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 STATE ROUTE 30
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-5518
Mailing Address - Country:US
Mailing Address - Phone:724-532-3422
Mailing Address - Fax:724-532-3424
Practice Address - Street 1:111 E CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1257
Practice Address - Country:US
Practice Address - Phone:724-238-2099
Practice Address - Fax:724-238-2119
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000912E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012785280003Medicaid
PA048476OtherHIGHMARK BC BS
PA0012785280002Medicaid