Healthcare Provider Details

I. General information

NPI: 1649404112
Provider Name (Legal Business Name): CHRISTINA M MCCLURKEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WASHINGTON AVENUE EXT
ALBANY NY
12203-5347
US

IV. Provider business mailing address

550 FRONTAGE RD STE 2415
NORTHFIELD IL
60093-1212
US

V. Phone/Fax

Practice location:
  • Phone: 518-724-3332
  • Fax: 518-456-2562
Mailing address:
  • Phone: 847-441-5593
  • Fax: 847-441-0734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number030383
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: