Provider Demographics
NPI:1346126117
Name:MCCLUNG, AYDEN MICHAEL (PTA)
Entity type:Individual
Prefix:
First Name:AYDEN
Middle Name:MICHAEL
Last Name:MCCLUNG
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4552 MCCLELLAN HWY
Mailing Address - Street 2:
Mailing Address - City:BRANCHLAND
Mailing Address - State:WV
Mailing Address - Zip Code:25506-8738
Mailing Address - Country:US
Mailing Address - Phone:304-741-2077
Mailing Address - Fax:
Practice Address - Street 1:4552 MCCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:BRANCHLAND
Practice Address - State:WV
Practice Address - Zip Code:25506-8738
Practice Address - Country:US
Practice Address - Phone:304-741-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV003050225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty