Active NPI
Kevin Wesley McClellan, PT
- Physical Therapist
- Tacoma, WA
National Provider Identifier
1043724024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 60785802
- Practice address
- 1802 S Union Ave Ste 100
Tacoma, WA 98405-1950 - Phone
- (253) 759-1310
- Fax
- (253) 759-1330
- NPI assigned
- Nov 28, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 60785802 | WA | Primary |
Addresses
Primary practice location
1802 S Union Ave Ste 100
Tacoma, WA 98405-1950
Mailing address
1802 S Union Ave Ste 100
Tacoma, WA 98405-1950
Phone (253) 759-1310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60785802 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511827200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511827200000",
"number": "1043724024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1802 S UNION AVE STE 100",
"city": "TACOMA",
"state": "WA",
"postal_code": "984051950",
"telephone_number": "253-759-1310",
"fax_number": "253-759-1330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1802 S UNION AVE STE 100",
"city": "TACOMA",
"state": "WA",
"postal_code": "984051950",
"telephone_number": "253-759-1310",
"fax_number": "253-759-1330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCLELLAN",
"first_name": "KEVIN",
"middle_name": "WESLEY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-28",
"last_updated": "2017-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "60785802",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.