Provider Demographics
NPI:1992109615
Name:MCCLAVE, SCOTT ARTHUR
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ARTHUR
Last Name:MCCLAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 YAKIMA AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3126
Mailing Address - Country:US
Mailing Address - Phone:805-501-5524
Mailing Address - Fax:
Practice Address - Street 1:6161 NE 175TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4800
Practice Address - Country:US
Practice Address - Phone:425-482-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60475839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist