Provider Demographics
NPI:1992326227
Name:MCCLEARY, DARREN TAYLOR (LPTA)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:TAYLOR
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6718
Mailing Address - Country:US
Mailing Address - Phone:443-922-0812
Mailing Address - Fax:
Practice Address - Street 1:7232 GERMAN HILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-1260
Practice Address - Country:US
Practice Address - Phone:410-282-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1340225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant