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General NPI Number Information
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NPI Number | 1295697977
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Entity Type | Individual
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Provider Name | ISABELLLE GRACE MCCLENEN
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Gender | Female
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Dates
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Enumeration Date | 12/01/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 1498 N BROADWAY ST
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City | GREENVILLE
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State | OH
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Zip | 45331-2454
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Country | US
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Telephone | 937-548-9495
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Fax |
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Provider Business Mailing Address
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Address Line | 5410 FORT RECOVERY RD
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City | HOUSTON
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State | OH
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Zip | 45333-9667
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Country | US
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Telephone | 937-658-2947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA014145
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License Number State | OH
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