MEDICARE: MR. DEAN M. CLENDENIN PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1326072240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEAN M. CLENDENIN PTA

Provider Business Mailing Address
First Line	:	44 E. 8TH STREET
Second Line	:	SUITE 205
City	:	HOLLAND
State	:	MI
Zip	:	49423
Country	:	US
Telephone Number	:	616-392-3197
Fax Number	:

Provider Business Practice Location Address
First Line	:	3491 LINCOLN RD
Second Line	:
City	:	HAMILTON
State	:	MI
Zip	:	49419-9512
Country	:	US
Telephone Number	:	269-751-2150
Fax Number	:	269-751-2140

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/02/2009

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