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NPI Code Detail

MEDICARE: MARNIE CLEMENS DPT

MEDICARE: MARNIE CLEMENS 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
1174400000XSpecialist001091WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4650023876OTHERWVRAILRAOD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101071873100OTHERWVWORKERS' COMPENSATION
2010718731002OTHERWVBC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
57508068OTHERWVAETNA
6398791OTHERWVOPTIMUM CHOICE
779582OTHERWVHEALTH ASSURANCE
8WV51916BOTHERWVHEALTH PLAN
91382862OTHERWVUMWA

General Provider Information

NPI Number : 1588666549
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARNIE CLEMENS DPT
Provider Business Mailing Address
First Line : 104 ORCHARD AVE
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-1736
Country : US
Telephone Number : 304-842-6008
Fax Number :
Provider Business Practice Location Address
First Line : 306 W MAIN ST
Second Line :
City : BRIDGEPORT
State : WV
Zip : 26330-1751
Country : US
Telephone Number : 304-842-3137
Fax Number : 304-842-3138
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2005
Last Update Date : 09/15/2017

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Directions to “ MARNIE CLEMENS DPT” Practice Location

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