Provider Demographics
NPI:1447904636
Name:MCCLENDON, EMMA DIANE (PTA)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:DIANE
Last Name:MCCLENDON
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 1:337 WORTHINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-6401
Mailing Address - Country:US
Mailing Address - Phone:864-202-1010
Mailing Address - Fax:
Practice Address - Street 1:1012 WILLIAM HILTON PKWY STE 7
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-2703
Practice Address - Country:US
Practice Address - Phone:843-715-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4792225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant