Provider Demographics
NPI:1134500655
Name:FLEMING, DEMETRIA LYNETTE (ATC)
Entity Type:Individual
Prefix:MS
First Name:DEMETRIA
Middle Name:LYNETTE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 TACOMA PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9107
Mailing Address - Country:US
Mailing Address - Phone:804-525-0212
Mailing Address - Fax:
Practice Address - Street 1:8014 TACOMA PLACE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-9107
Practice Address - Country:US
Practice Address - Phone:804-525-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20000208212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer