Healthcare Provider Details

I. General information

NPI: 1932191301
Provider Name (Legal Business Name): JENNIFER MCCLURE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST FAIDLEY MEDICAL CENTER, 620 N. DIERS SUITE 300
GRAND ISLAND NE
68802
US

IV. Provider business mailing address

2425 SOTHMAN DR
GRAND ISLAND NE
68801-7260
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0344
  • Fax:
Mailing address:
  • Phone: 308-381-0226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2437
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: