Provider Demographics
NPI:1346448917
Name:LEFEVER, CLINTON THOMAS (PT)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:THOMAS
Last Name:LEFEVER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MEDPARK DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2734
Mailing Address - Country:US
Mailing Address - Phone:606-679-1761
Mailing Address - Fax:606-678-0971
Practice Address - Street 1:175 MEDPARK DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2734
Practice Address - Country:US
Practice Address - Phone:606-679-1761
Practice Address - Fax:606-678-0971
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY225875OtherBCBS
KY879003950Medicaid