Provider Demographics
NPI:1104075019
Name:MCCLAIN, PAUL H (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:H
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CASA BUENA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1709
Mailing Address - Country:US
Mailing Address - Phone:415-924-4525
Mailing Address - Fax:
Practice Address - Street 1:101 CASA BUENA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1709
Practice Address - Country:US
Practice Address - Phone:415-924-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic