MEDICARE: MRS. REBECCA JO MCCLURE PT, MOMT

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	11-01822	KS

General Provider Information

NPI Number	:	1730391780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA JO MCCLURE PT, MOMT

Provider Business Mailing Address
First Line	:	108 LAWRENCE AVE
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-1824
Country	:	US
Telephone Number	:	785-841-7631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 CLINTON PL
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-2195
Country	:	US
Telephone Number	:	785-840-3780
Fax Number	:	785-312-6707

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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