Provider Demographics
NPI:1699568386
Name:MCCLELLAND, ANDRIA NICOLE
Entity type:Individual
Prefix:
First Name:ANDRIA
Middle Name:NICOLE
Last Name:MCCLELLAND
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 1:1383 MISTLETOE RIDGE PL NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7877
Mailing Address - Country:US
Mailing Address - Phone:440-654-0648
Mailing Address - Fax:
Practice Address - Street 1:3700 TAYLOR GLEN LN NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3400
Practice Address - Country:US
Practice Address - Phone:704-259-4763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant