Provider Demographics
NPI:1194887091
Name:MCCLAIN, SUSAN MARY (MPT, CERT MDT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:MPT, CERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3411 SILVERSIDE RD
Mailing Address - Street 2:SUITE 105 SPRINGER BLDG
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4812
Mailing Address - Country:US
Mailing Address - Phone:302-655-5877
Mailing Address - Fax:302-655-0825
Practice Address - Street 1:2100 BAYNARD BLVD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-3900
Practice Address - Country:US
Practice Address - Phone:302-655-5877
Practice Address - Fax:302-655-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000969225100000X
PAPT0009272L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist