Provider Demographics
NPI:1134544141
Name:MCCLURE, HEIDI LYNN (LMT)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:LYNN
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:LYNN
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:961 E 54TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1601
Mailing Address - Country:US
Mailing Address - Phone:646-242-8477
Mailing Address - Fax:
Practice Address - Street 1:603 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3405
Practice Address - Country:US
Practice Address - Phone:646-242-8477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist