Provider Demographics
NPI:1033244181
Name:KLEMM, MARY ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:KLEMM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:HARLEY KLEMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1210 SE MAYNARD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6943
Mailing Address - Country:US
Mailing Address - Phone:919-297-0280
Mailing Address - Fax:919-297-0281
Practice Address - Street 1:1210 SE MAYNARD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6943
Practice Address - Country:US
Practice Address - Phone:919-297-0280
Practice Address - Fax:919-297-0281
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC078UIOtherBCBS STATE