Provider Demographics
NPI:1871084830
Name:MCCLARY, NICHOLAS (DPT)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:MCCLARY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NOLAN CV STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3162
Mailing Address - Country:US
Mailing Address - Phone:731-512-0302
Mailing Address - Fax:731-512-0319
Practice Address - Street 1:28 NOLAN CV STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3162
Practice Address - Country:US
Practice Address - Phone:731-512-0302
Practice Address - Fax:731-512-0319
Is Sole Proprietor?:No
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist