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NPI Code Detail

MEDICARE: CARI L MCCLELLAN DPT

MEDICARE: CARI L MCCLELLAN DPT
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
1225100000XPhysical Therapist5501012777MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OP44090OTHERMIMEDICARE GROUP NUMBER

General Provider Information

NPI Number : 1265590400
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARI L MCCLELLAN DPT
Provider Business Mailing Address
First Line : 625 ENTERPRISE DR
Second Line :
City : OAK BROOK
State : IL
Zip : 60523-8813
Country : US
Telephone Number : 630-575-6200
Fax Number : 630-928-5080
Provider Business Practice Location Address
First Line : 23800 ORCHARD LAKE RD STE 101
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48336-2561
Country : US
Telephone Number : 248-474-5516
Fax Number : 248-474-5519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 07/21/2022

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Directions to “ CARI L MCCLELLAN DPT” Practice Location

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