MEDICARE: LAURA FLAHERTY CLEMMONS D.P.T.

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	225100000X	Physical Therapist	PT60141891	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417271271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA FLAHERTY CLEMMONS D.P.T.

Provider Business Mailing Address
First Line	:	21009 76TH AVE W
Second Line	:	AXIS PHYSICAL THERAPY INC
City	:	EDMONDS
State	:	WA
Zip	:	98026-7126
Country	:	US
Telephone Number	:	425-672-2910
Fax Number	:	425-778-1872

Provider Business Practice Location Address
First Line	:	21009 76TH AVE W
Second Line	:	AXIS PHYSICAL THERAPY INC
City	:	EDMONDS
State	:	WA
Zip	:	98026-7126
Country	:	US
Telephone Number	:	425-672-2910
Fax Number	:	425-778-1872

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

Provider Enumeration Date	:	03/23/2010
Last Update Date	:	09/15/2017

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