Provider Demographics
NPI:1912339276
Name:MCCLAVE, MACHIKO (DPT)
Entity Type:Individual
Prefix:
First Name:MACHIKO
Middle Name:
Last Name:MCCLAVE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MACHI
Other - Middle Name:
Other - Last Name:NINOMIYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:100 NE GILMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2925
Mailing Address - Country:US
Mailing Address - Phone:425-557-8000
Mailing Address - Fax:425-557-8014
Practice Address - Street 1:100 NE GILMAN BLVD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-557-8000
Practice Address - Fax:425-557-8014
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60335794225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist