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NPI Code Detail

MEDICARE: DR. BRENDA SUE CLEMENTS DPT, MTC

MEDICARE: DR. BRENDA SUE CLEMENTS DPT, MTC
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
1225100000XPhysical TherapistPT19943FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12288818OTHERFLAETNA
2Y909JOTHERFLBCBS PROVIDER NUMBER

General Provider Information

NPI Number : 1720077670
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRENDA SUE CLEMENTS DPT, MTC
Provider Business Mailing Address
First Line : 1827 HARRISON AVE
Second Line : BUILDING 4
City : PANAMA CITY
State : FL
Zip : 32405-7605
Country : US
Telephone Number : 850-872-7022
Fax Number : 850-872-7021
Provider Business Practice Location Address
First Line : 1827 HARRISON AVE
Second Line : BUILDING 4
City : PANAMA CITY
State : FL
Zip : 32405-7605
Country : US
Telephone Number : 850-872-7022
Fax Number : 850-872-7021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 09/25/2013

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