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General NPI Number Information
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NPI Number | 1134171994
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Entity Type | Individual
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Provider Name | CHESSON P CLEMENT PT, MPT
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Gender | Male
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 1455 E PUTNAM AVE
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City | OLD GREENWICH
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State | CT
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Zip | 06870-1360
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Country | US
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Telephone | 203-817-0196
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Fax | 203-817-0199
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Provider Business Mailing Address
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Address Line | 102 WOODLAND HWY STE 1
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City | BELLE CHASSE
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State | LA
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Zip | 70037-1674
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Country | US
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Telephone | 504-392-7000
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Fax | 504-584-7747
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 04724
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 14581
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License Number State | CT
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