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NPI Code Detail

MEDICARE: MS. CLAIR JOHANNA RADLIFF

MEDICARE: MS. CLAIR JOHANNA RADLIFF
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
1225200000XPhysical Therapy Assistant2086750TX

General Provider Information

NPI Number : 1588935605
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CLAIR JOHANNA RADLIFF
Provider Business Mailing Address
First Line : 216 S 29TH ST
Second Line :
City : HARRISBURG
State : PA
Zip : 17103-1916
Country : US
Telephone Number : 302-358-7380
Fax Number :
Provider Business Practice Location Address
First Line : 810 BELLAIRE ST
Second Line :
City : JACKSONVILLE
State : TX
Zip : 75766-9045
Country : US
Telephone Number : 903-589-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2012
Last Update Date : 01/20/2012

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