Healthcare Provider Details

I. General information

NPI: 1134171994
Provider Name (Legal Business Name): CHESSON P CLEMENT PT, MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E PUTNAM AVE
OLD GREENWICH CT
06870-1360
US

IV. Provider business mailing address

102 WOODLAND HWY STE 1
BELLE CHASSE LA
70037-1674
US

V. Phone/Fax

Practice location:
  • Phone: 203-817-0196
  • Fax: 203-817-0199
Mailing address:
  • Phone: 504-392-7000
  • Fax: 504-584-7747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number04724
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14581
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: