Basic Information
| Provider Information | |||||||||
| NPI: | 1790370443 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLURE | ||||||||
| FirstName: | CONOR | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 524 ABERDEEN DR APT 202 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275164016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285514400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 300 MARKET ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275160448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9845288787 | ||||||||
| FaxNumber: | 9842461223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2021 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | P19749 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.