MEDICARE: MRS. KATHERINE ELAINE MCCLAIN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2820	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86059251885704C012	OTHER	AZ	TRICARE

General Provider Information

NPI Number	:	1588661128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE ELAINE MCCLAIN PT

Provider Business Mailing Address
First Line	:	5501 N ORACLE RD
Second Line	:	STE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-3850
Country	:	US
Telephone Number	:	520-293-5551
Fax Number	:	520-293-6638

Provider Business Practice Location Address
First Line	:	5501 N ORACLE RD
Second Line	:	STE 101
City	:	TUCSON
State	:	AZ
Zip	:	85704-3850
Country	:	US
Telephone Number	:	520-293-5551
Fax Number	:	520-293-6638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	09/03/2010

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