Healthcare Provider Details

I. General information

NPI: 1326072240
Provider Name (Legal Business Name): DEAN M. CLENDENIN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 LINCOLN RD
HAMILTON MI
49419-9512
US

IV. Provider business mailing address

44 E. 8TH STREET SUITE 205
HOLLAND MI
49423
US

V. Phone/Fax

Practice location:
  • Phone: 269-751-2150
  • Fax: 269-751-2140
Mailing address:
  • Phone: 616-392-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: