Provider Demographics
NPI:1720104870
Name:MCCLAIN, PATRICK BRIAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:BRIAN
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FORREST PARK WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72936-5955
Mailing Address - Country:US
Mailing Address - Phone:479-996-5078
Mailing Address - Fax:479-996-5079
Practice Address - Street 1:515 FORREST PARK WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:AR
Practice Address - Zip Code:72936-5955
Practice Address - Country:US
Practice Address - Phone:479-996-5078
Practice Address - Fax:479-996-5079
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X522OtherPROVIDER NUMBER
AR5C918Medicare ID - Type UnspecifiedPROVIDER NUMBER