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NPI Code Detail

MEDICARE: MARY C CLEMMENT

MEDICARE: MARY C CLEMMENT
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 Assistant219WI

Other Identifiers

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

General Provider Information

NPI Number : 1942328919
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY C CLEMMENT
Provider Business Mailing Address
First Line : S2261 YELLOW THUNDER TRL
Second Line :
City : BARABOO
State : WI
Zip : 53913-9356
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4502 MILWAUKEE ST
Second Line :
City : MADISON
State : WI
Zip : 53714-2133
Country : US
Telephone Number : 608-249-2137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2007
Last Update Date : 11/08/2012

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Directions to “ MARY C CLEMMENT ” Practice Location

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