MEDICARE: VALERIE KAYE MCCLAIN PTA

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	225200000X	Physical Therapy Assistant	20221424	TX

General Provider Information

NPI Number	:	1356719934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE KAYE MCCLAIN PTA

Provider Business Mailing Address
First Line	:	11633 EMORY TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-8805
Country	:	US
Telephone Number	:	817-781-3437
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 SW GREEN OAKS BLVD
Second Line	:	SUITE 109
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4130
Country	:	US
Telephone Number	:	817-557-2030
Fax Number	:	817-557-3895

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

Provider Enumeration Date	:	09/13/2015
Last Update Date	:	09/13/2015

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