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General NPI Number Information
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NPI Number | 1417670274
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Entity Type | Individual
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Provider Name | TAYLOR GRACE CLEMMER PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 7030 PINE FOREST RD
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City | PENSACOLA
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State | FL
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Zip | 32526-3920
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Country | US
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Telephone | 850-944-5360
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Fax |
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Provider Business Mailing Address
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Address Line | 5465 ROUTE 309
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City | CENTER VALLEY
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State | PA
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Zip | 18034-9601
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Country | US
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Telephone | 484-264-6696
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Fax |
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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 | 1386852
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License Number State | TX
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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 | PT39758
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License Number State | FL
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