MEDICARE: MICHAEL GREGORY MCCLAIN MSPT

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	225100000X	Physical Therapist	6425	TN

General Provider Information

NPI Number	:	1558486183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GREGORY MCCLAIN MSPT

Provider Business Mailing Address
First Line	:	113 LEE CARTER DR
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-3095
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 PRINCETON RD
Second Line	:	SUITE 150
City	:	JOHNSON CITY
State	:	TN
Zip	:	37601-2062
Country	:	US
Telephone Number	:	423-283-7068
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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