Healthcare Provider Details

I. General information

NPI: 1548518327
Provider Name (Legal Business Name): THOMAS EDWARD MCCLANAHAN III PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 GLEN ESTE WITHAMSVILLE RD SUITE 500
CINCINNATI OH
45245-1318
US

IV. Provider business mailing address

4440 GLEN ESTE WITHAMSVILLE RD SUITE 500
CINCINNATI OH
45245-1318
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-3630
  • Fax: 513-753-4308
Mailing address:
  • Phone: 513-943-3630
  • Fax: 513-753-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.013674
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: