=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114896461
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANA J. CLEMENTS DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2025
-----------------------------------------------------
Last Update Date | 11/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 104 53RD AVE E
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34203-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-925-2700
-----------------------------------------------------
Fax | 941-925-7744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25066
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34277-2066
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-925-2700
-----------------------------------------------------
Fax | 941-925-7744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT43818
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------