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General NPI Number Information
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NPI Number | 1326118415
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Entity Type | Individual
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Provider Name | STEPHEN M MCCLELLAN P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 11/07/2016
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Provider Practice Location Address
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Address Line | 5194 HIGHWAY 100 SUITE 105
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City | LYLES
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State | TN
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Zip | 37098-2821
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Country | US
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Telephone | 931-670-6161
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Fax | 931-670-6355
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Provider Business Mailing Address
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Address Line | 5194 HIGHWAY 100 SUITE 105
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City | LYLES
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State | TN
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Zip | 37098-2821
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Country | US
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Telephone | 931-670-6161
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Fax | 931-670-6355
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT3001
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License Number State | TN
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