Provider Demographics
NPI:1124623194
Name:MCCLAIN, EKATERINA GRACE
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:GRACE
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PIDGEON HILL DR STE 10
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6153
Mailing Address - Country:US
Mailing Address - Phone:703-999-4509
Mailing Address - Fax:
Practice Address - Street 1:10 PIDGEON HILL DR STE 10
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6153
Practice Address - Country:US
Practice Address - Phone:571-313-0804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist