Provider Demographics
NPI:1346907417
Name:MCLENDON, DORIANNE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:DORIANNE
Middle Name:MARIE
Last Name:MCLENDON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 THORNCREST DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27539-9509
Mailing Address - Country:US
Mailing Address - Phone:561-302-3963
Mailing Address - Fax:
Practice Address - Street 1:300 MEREDITH DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-2681
Practice Address - Country:US
Practice Address - Phone:919-504-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA6276225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant