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General NPI Number Information
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NPI Number | 1902921141
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Entity Type | Individual
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Provider Name | JONATHAN ROBERT MCCLUNG DPT
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 N COLUMBIA AVE
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City | SEWARD
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State | NE
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Zip | 68434-2228
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Country | US
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Telephone | 402-646-4611
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 SW 17TH ST
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City | LINCOLN
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State | NE
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Zip | 68522-1585
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Country | US
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Telephone | 402-613-7992
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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 | 2377
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3911
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License Number State | IA
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