Healthcare Provider Details

I. General information

NPI: 1609756436
Provider Name (Legal Business Name): MCCLELLAN THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 E 20TH ST STE A
FARMINGTON NM
87401-4281
US

IV. Provider business mailing address

5608 FAIRWAY DR
FARMINGTON NM
87402-5027
US

V. Phone/Fax

Practice location:
  • Phone: 505-459-3788
  • Fax:
Mailing address:
  • Phone: 505-459-3788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAN MCCLELLAN
Title or Position: OWNER
Credential: PT, DPT
Phone: 505-459-3788