Provider Demographics
NPI:1790113694
Name:MCCLEARY, JAMIE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 DOWNING ST
Mailing Address - Street 2:APT 607
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2980
Mailing Address - Country:US
Mailing Address - Phone:315-529-4163
Mailing Address - Fax:
Practice Address - Street 1:777 29TH ST STE 102
Practice Address - Street 2:PELVIC THERAPY SPECIALISTS, PC
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2316
Practice Address - Country:US
Practice Address - Phone:303-601-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist