Basic Information
| Provider Information | |||||||||
| NPI: | 1578713814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLENDON | ||||||||
| FirstName: | JACQUELYN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1367 MOREHEAD RD | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421018828 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 421 SEWELL DR | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385831223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317384325 | ||||||||
| FaxNumber: | 9317384120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2008 | ||||||||
| LastUpdateDate: | 02/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.