Provider Demographics
NPI:1912031493
Name:MCCLAUGHRY, MICHAEL L (P T)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:L
Last Name:MCCLAUGHRY
Suffix:
Gender:M
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROCKER CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049
Mailing Address - Country:US
Mailing Address - Phone:573-365-4035
Mailing Address - Fax:
Practice Address - Street 1:5497A HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3026
Practice Address - Country:US
Practice Address - Phone:573-302-1288
Practice Address - Fax:573-302-1384
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO102576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist