1841368123 NPI number — NOEL JUNE FERNANDEZ MCCLUNEY PT, DPT

Table of content: NOEL JUNE FERNANDEZ MCCLUNEY PT, DPT (NPI 1841368123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841368123 NPI number — NOEL JUNE FERNANDEZ MCCLUNEY PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCLUNEY
Provider First Name:
NOEL
Provider Middle Name:
JUNE FERNANDEZ
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERNANDEZ
Provider Other First Name:
NOEL
Provider Other Middle Name:
JUNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841368123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 E HAYDEN LN
Provider Second Line Business Mailing Address:
APT 104
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85281-7722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-967-7334
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 E UNIVERSITY DR
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85213-8478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-649-1750
Provider Business Practice Location Address Fax Number:
480-649-1638
Provider Enumeration Date:
12/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  7419 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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