Individual ProviderGwen Ann McclurePhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address481 Oaklawn Ave, 481 Oaklawn Avenue, Green Bay, WI 54304-4929(920) 433-0533PECOS EnrollmentBased on the most recent information from CMS, provider Gwen Ann Mcclure does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1477726842Provider TypeIndividualFull NameMcclure, Gwen AnnTitleMrs.CredentialLPTAGenderFemaleSole ProprietorYesEnumeration Date4/8/2008Last Updated4/8/2008Contact InformationPractice LocationPractice Address481 Oaklawn Ave, 481 Oaklawn Avenue, Green Bay, WI 54304-4929Phone(920) 433-0533FaxUnlisted FaxMailing LocationMailing Address481 Oaklawn Ave, 481 Oaklawn Avenue, Green Bay, WI 54304-4929Phone(920) 433-0533FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225200000XPrimaryDescriptionPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1037-019WisconsinProvider IdentifiersIDDescriptionIssuerID40211400DescriptionMedicaidIssuerUnlistedWisconsin