MEDICARE: MADYSON P CLEMENTS 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	16702	TN

General Provider Information

NPI Number	:	1720959877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADYSON P CLEMENTS DPT

Provider Business Mailing Address
First Line	:	2000 MONARCH PT
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4637
Country	:	US
Telephone Number	:	423-609-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 MONARCH PT
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-4637
Country	:	US
Telephone Number	:	423-609-7997
Fax Number	:

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

Provider Enumeration Date	:	09/12/2025
Last Update Date	:	09/12/2025

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