Provider Demographics
NPI:1346204211
Name:CLARY, MARTY K (MSRPT)
Entity Type:Individual
Prefix:MR
First Name:MARTY
Middle Name:K
Last Name:CLARY
Suffix:
Gender:M
Credentials:MSRPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 51435
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673
Mailing Address - Country:US
Mailing Address - Phone:864-335-4018
Mailing Address - Fax:864-335-4019
Practice Address - Street 1:3400-D ANDERSON ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29611-7651
Practice Address - Country:US
Practice Address - Phone:864-335-4018
Practice Address - Fax:864-335-4019
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4092225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8419Medicare ID - Type UnspecifiedGROUP ID NUMBER
Q34072Medicare ID - Type Unspecified