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General NPI Number Information
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NPI Number | 1790887065
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Entity Type | Individual
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Provider Name | ELMER CLORINA
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Gender | Male
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Dates
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Enumeration Date | 09/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5865 RIDGEWAY CENTER PARKWAY SUITE 300
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City | MEMPHIS
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State | TN
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Zip | 38120
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Country | US
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Telephone | 901-820-4335
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Fax | 901-820-4336
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Provider Business Mailing Address
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Address Line | P.O BOX 4092
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City | CORDOVA
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State | TN
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Zip | 38088-4092
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Country | US
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Telephone | 901-262-1996
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Fax | 901-737-7843
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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 | PT4336
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License Number State | TN
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