Provider Demographics
NPI:1184655920
Name:CLEMENS, ELIZABETH ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:LIZ
Other - Middle Name:ANNE
Other - Last Name:CLEMENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:10316 45TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-8122
Mailing Address - Country:US
Mailing Address - Phone:206-528-0519
Mailing Address - Fax:206-528-0519
Practice Address - Street 1:8028 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4815
Practice Address - Country:US
Practice Address - Phone:206-524-0124
Practice Address - Fax:206-524-0125
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0142109OtherLABOR AND INDUSTRIES
WA4131OtherMOLINA HEALTHCARE OF WA
WA8901755OtherCRIME VICTIMS COMP
WA8334815Medicaid
WA0142109OtherLABOR AND INDUSTRIES