MEDICARE: MRS. LINDA MARIE MCCLANAHAN PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	424	NM

General Provider Information

NPI Number	:	1154426971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LINDA MARIE MCCLANAHAN PT

Provider Business Mailing Address
First Line	:	9201 MONTGOMERY BLVD NE
Second Line	:	SUITE 302
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2468
Country	:	US
Telephone Number	:	505-293-6262
Fax Number	:	505-293-6622

Provider Business Practice Location Address
First Line	:	9201 MONTGOMERY BLVD NE
Second Line	:	SUITE 302
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2468
Country	:	US
Telephone Number	:	505-293-6262
Fax Number	:	505-293-6622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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