MEDICARE: JESSICA MCCLELLAN 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	225100000X	Physical Therapist	PT11272	OH

General Provider Information

NPI Number	:	1588641021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MCCLELLAN PT

Provider Business Mailing Address
First Line	:	23825 COMMERCE PARK
Second Line	:	SUITE B
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5837
Country	:	US
Telephone Number	:	216-292-6363
Fax Number	:	216-292-6306

Provider Business Practice Location Address
First Line	:	15900 SNOW RD
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-2859
Country	:	US
Telephone Number	:	216-265-3454
Fax Number	:	216-267-5553

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/08/2007

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