Healthcare Provider Details

I. General information

NPI: 1386867075
Provider Name (Legal Business Name): CLARA YVONNE DEWEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MIDDLEFORD RD
SEAFORD DE
19973-3636
US

IV. Provider business mailing address

9812 SUNNYSIDE RD
BRIDGEVILLE DE
19933-4702
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-6611
  • Fax:
Mailing address:
  • Phone: 302-337-3601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number0000275
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: