Provider Demographics
NPI:1275302499
Name:CAROLINE MCCLEMONS
Entity Type:Organization
Organization Name:CAROLINE MCCLEMONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:619-920-7873
Mailing Address - Street 1:1532 AVENIDA DE LAS ADELSAS
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4714
Mailing Address - Country:US
Mailing Address - Phone:619-920-7873
Mailing Address - Fax:
Practice Address - Street 1:247 S HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1807
Practice Address - Country:US
Practice Address - Phone:760-230-5432
Practice Address - Fax:760-655-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy