Healthcare Provider Details

I. General information

NPI: 1053719971
Provider Name (Legal Business Name): CHRISTIE CLEM PT, DPT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 BACON ST
DURHAM NC
27703-5006
US

IV. Provider business mailing address

808 BACON ST
DURHAM NC
27703-5006
US

V. Phone/Fax

Practice location:
  • Phone: 919-560-2263
  • Fax:
Mailing address:
  • Phone: 919-560-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1579
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP16568
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: