Healthcare Provider Details

I. General information

NPI: 1104207943
Provider Name (Legal Business Name): MICHAEL A MCCLAIN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MAHONE DR
ARTESIA NM
88210-2046
US

IV. Provider business mailing address

PO BOX 2860
ALAMOGORDO NM
88311-2860
US

V. Phone/Fax

Practice location:
  • Phone: 575-746-2566
  • Fax: 575-746-6260
Mailing address:
  • Phone: 575-439-1397
  • Fax: 575-437-2622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA-1133
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: