Provider Demographics
NPI:1972543270
Name:MCCLENAGHAN, BRUCE ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ANDREW
Last Name:MCCLENAGHAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 HEYWARD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2525
Mailing Address - Country:US
Mailing Address - Phone:803-777-6583
Mailing Address - Fax:
Practice Address - Street 1:PT PROGRAM, DEPT OF EXERCISE SCIENCE
Practice Address - Street 2:UNIVERSITY OF SOUTH CAROLINA
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205
Practice Address - Country:US
Practice Address - Phone:803-777-6583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist