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General NPI Number Information
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NPI Number | 1356486930
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Entity Type | Individual
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Provider Name | BRIAN ALVIN MCCLELLAN PT
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 130 W RAVINE RD
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City | KINGSPORT
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State | TN
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Zip | 37660-3810
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Country | US
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Telephone | 423-224-5510
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Fax | 423-224-5544
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Provider Business Mailing Address
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Address Line | 406 CREEKSIDE DR
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City | MOUNT CARMEL
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State | TN
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Zip | 37645-3678
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Country | US
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Telephone | 423-384-5431
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 7276
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License Number State | TN
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