Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 52622 | AL |
N | 2251S0007X | Physical Therapist - Sports | 21002 | MA |
NPI | 1205223872 |
---|---|
Provider Name | Paige Mcclees |
First Address | Bolingbrook, IL 60440-4909 |
Second Address | Birmingham, AL 35205-1609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2015 |
Last Update Date | 01/11/2017 |