Provider Demographics
NPI:1912024670
Name:MCLAINE, ALICE J (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:J
Last Name:MCLAINE
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E CHEVAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-6956
Mailing Address - Country:US
Mailing Address - Phone:803-547-0329
Mailing Address - Fax:
Practice Address - Street 1:600 E CHEVAL DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6956
Practice Address - Country:US
Practice Address - Phone:803-547-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer