Basic Information
| Provider Information | |||||||||
| NPI: | 1194887091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLAIN | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | MPT, CERT. MDT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3411 SILVERSIDE RD | ||||||||
| Address2: | SUITE 105 SPRINGER BLDG | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198104812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026555877 | ||||||||
| FaxNumber: | 3026550825 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 BAYNARD BLVD | ||||||||
| Address2: | LOWER LEVEL | ||||||||
| City: | WILMINGTON | ||||||||
| State: | DE | ||||||||
| PostalCode: | 198023900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026555877 | ||||||||
| FaxNumber: | 3026550825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0000969 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT0009272L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.