Provider Demographics
NPI:1376978361
Name:TAPLEY, CLARENCE WILBORN III (PT)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:WILBORN
Last Name:TAPLEY
Suffix:III
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 1:1149 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-8273
Mailing Address - Country:US
Mailing Address - Phone:662-542-0491
Mailing Address - Fax:
Practice Address - Street 1:1149 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-8273
Practice Address - Country:US
Practice Address - Phone:662-542-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT1029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist