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General NPI Number Information
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NPI Number | 1902212475
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Entity Type | Individual
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Provider Name | MICHAEL CLEVINGER
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Gender | Male
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Dates
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Enumeration Date | 07/06/2014
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Last Update Date | 07/06/2014
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Provider Practice Location Address
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Address Line | 2001 RIDGEWOOD DR
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City | SALEM
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State | VA
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Zip | 24153-7126
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Country | US
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Telephone | 540-387-4945
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 MEMORIAL AVE SW APT 93
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City | ROANOKE
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State | VA
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Zip | 24015-1916
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Country | US
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Telephone | 540-598-6960
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306601271
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License Number State | VA
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