Healthcare Provider Details

I. General information

NPI: 1154426971
Provider Name (Legal Business Name): LINDA MARIE MCCLANAHAN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 MONTGOMERY BLVD NE SUITE 302
ALBUQUERQUE NM
87111-2468
US

IV. Provider business mailing address

9201 MONTGOMERY BLVD NE SUITE 302
ALBUQUERQUE NM
87111-2468
US

V. Phone/Fax

Practice location:
  • Phone: 505-293-6262
  • Fax: 505-293-6622
Mailing address:
  • Phone: 505-293-6262
  • Fax: 505-293-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number424
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: