NPI 1073134177

Matthew Bruce McClellan, CPO

Practitioner Prosthetist Tyler, TX

Practice location

Address: 1122 E Front St, Tyler, TX 75702-8414
Phone: (903) 592-6574
Fax: (903) 595-3862

Registered specialties (2)

Prosthetist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224P00000X Licence 2047 (TX)

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Orthotist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X Licence 2047 (TX)

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Registry record

NPI: 1073134177
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 Apr 2020
Record last updated: 29 Apr 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.