Healthcare Provider Details

I. General information

NPI: 1609868637
Provider Name (Legal Business Name): MATTHEW CLEMENS P. T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 W COMMERCIAL ST SUITE 1275
E ROCHESTER NY
14445-2407
US

IV. Provider business mailing address

125 LATTIMORE RD SUITE 125
ROCHESTER NY
14620-4159
US

V. Phone/Fax

Practice location:
  • Phone: 585-264-0370
  • Fax: 585-264-0432
Mailing address:
  • Phone: 585-442-9110
  • Fax: 585-442-9049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020142
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: