Provider Demographics
NPI:1689379349
Name:MCCLUNG, BROOKE WHITNEY (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:WHITNEY
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 BOSTON POST RD BLDG 5
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3480
Practice Address - Country:US
Practice Address - Phone:978-639-4800
Practice Address - Fax:978-731-0971
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACP026693T225100000X
225100000X
MA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist