Provider Demographics
NPI:1669851937
Name:MCCLELLAN, KATIE (DPT)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19931 W KELLOGG DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:GODDARD
Mailing Address - State:KS
Mailing Address - Zip Code:67052-8864
Mailing Address - Country:US
Mailing Address - Phone:316-550-6132
Mailing Address - Fax:316-550-6215
Practice Address - Street 1:19931 W KELLOGG DR UNIT A
Practice Address - Street 2:
Practice Address - City:GODDARD
Practice Address - State:KS
Practice Address - Zip Code:67052-8864
Practice Address - Country:US
Practice Address - Phone:316-550-6132
Practice Address - Fax:316-550-6132
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist