Provider Demographics
NPI:1114678513
Name:CLEMMONS, RALPH PAUL (PTA)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:PAUL
Last Name:CLEMMONS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30302 BUMBLE BEE DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3718
Mailing Address - Country:US
Mailing Address - Phone:702-556-1605
Mailing Address - Fax:
Practice Address - Street 1:3101 PLUMAS ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4515
Practice Address - Country:US
Practice Address - Phone:702-556-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-0648225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant