Provider Demographics
NPI:1164648077
Name:CLEMMER, BRANDY PERDUE (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:PERDUE
Last Name:CLEMMER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 HINSON DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5517
Mailing Address - Country:US
Mailing Address - Phone:704-233-8350
Mailing Address - Fax:704-233-8295
Practice Address - Street 1:203 N CAMDEN ST
Practice Address - Street 2:
Practice Address - City:WINGATE
Practice Address - State:NC
Practice Address - Zip Code:28174
Practice Address - Country:US
Practice Address - Phone:704-233-8350
Practice Address - Fax:704-233-8295
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC05422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer