Healthcare Provider Details

I. General information

NPI: 1851908370
Provider Name (Legal Business Name): EMILY CLONCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 UNIVERSITY SHOPPING CTR
RICHMOND KY
40475-2614
US

IV. Provider business mailing address

55 FOX TRL
LONDON KY
40744-8195
US

V. Phone/Fax

Practice location:
  • Phone: 859-624-5684
  • Fax:
Mailing address:
  • Phone: 865-585-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberTP2020064
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: