Provider Demographics
NPI:1952478059
Name:MCCLURE, HOLLY N (PT)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:N
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 PIPER STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:907-561-0214
Practice Address - Street 1:3831 PIPER STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:907-561-0214
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1783225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT0017Medicaid
AKK160888Medicare PIN