Healthcare Provider Details

I. General information

NPI: 1588599955
Provider Name (Legal Business Name): MACIE MCCLURE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 CUMBERLAND FALLS HWY
CORBIN KY
40701-2721
US

IV. Provider business mailing address

1480 CUMBERLAND FALLS HWY
CORBIN KY
40701-2721
US

V. Phone/Fax

Practice location:
  • Phone: 606-524-7818
  • Fax:
Mailing address:
  • Phone: 606-524-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009568
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: