Provider Demographics
NPI:1861637142
Name:MCLANE, CHRISTY BETH
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:BETH
Last Name:MCLANE
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 1:37699 6 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3994
Mailing Address - Country:US
Mailing Address - Phone:734-953-4155
Mailing Address - Fax:734-953-1622
Practice Address - Street 1:37699 6 MILE RD STE 200
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3994
Practice Address - Country:US
Practice Address - Phone:734-953-4155
Practice Address - Fax:734-953-1622
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010514225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist