MEDICARE: MR. MARTY K CLARY MSRPT

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	4092	SC

General Provider Information

NPI Number	:	1346204211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARTY K CLARY MSRPT

Provider Business Mailing Address
First Line	:	P.O. BOX 51435
Second Line	:
City	:	PIEDMONT
State	:	SC
Zip	:	29673
Country	:	US
Telephone Number	:	864-335-4018
Fax Number	:	864-335-4019

Provider Business Practice Location Address
First Line	:	3400-D ANDERSON ROAD
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7651
Country	:	US
Telephone Number	:	864-335-4018
Fax Number	:	864-335-4019

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

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/08/2007

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