MEDICARE: CLARENCE HERBERT CLIFTON III DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	7856	TN

General Provider Information

NPI Number	:	1144528092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARENCE HERBERT CLIFTON III DPT

Provider Business Mailing Address
First Line	:	800 CRESCENT CENTRE DR STE 300
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-7285
Country	:	US
Telephone Number	:	615-373-1350
Fax Number	:	615-221-9054

Provider Business Practice Location Address
First Line	:	4957 SWINYAR DR STE 103
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363-2205
Country	:	US
Telephone Number	:	423-664-0800
Fax Number	:	423-664-0801

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	10/03/2019

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