Provider Demographics
NPI:1306804570
Name:MCCLURE, ANNE (PT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 SW 38TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7013
Mailing Address - Country:US
Mailing Address - Phone:580-351-9956
Mailing Address - Fax:580-351-9395
Practice Address - Street 1:910 SW 38TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7013
Practice Address - Country:US
Practice Address - Phone:580-351-9956
Practice Address - Fax:580-351-9395
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK2557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK610134700OtherDOL PROVIDER NUMBER