Provider Demographics
NPI:1164753372
Name:CLEMANS, JOELLEN DEE (PT)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:DEE
Last Name:CLEMANS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOELLEN
Other - Middle Name:DEE
Other - Last Name:NUTTALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5395 VISTA SIERRA
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3022
Mailing Address - Country:US
Mailing Address - Phone:714-931-6955
Mailing Address - Fax:
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-492-9785
Practice Address - Fax:562-491-9683
Is Sole Proprietor?:No
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist