Individual
STEFAN MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1530 BROAD AVE, GULFPORT, MS 39501-3601
(228) 864-6544
Mailing address
1101 19TH ST, GULFPORT, MS 39501-3312
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
7161
MS
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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