Provider Demographics
NPI:1285680009
Name:SINGLETARY, CLARENCE DWAYNE (RPT)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:DWAYNE
Last Name:SINGLETARY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 ELMS CV
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1046
Mailing Address - Country:US
Mailing Address - Phone:601-842-6612
Mailing Address - Fax:601-853-8156
Practice Address - Street 1:1007 ELMS CV
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1046
Practice Address - Country:US
Practice Address - Phone:601-842-6612
Practice Address - Fax:601-853-8156
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist