Provider Demographics
NPI:1407334055
Name:CLEMENTS, MARINA JOANNE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:JOANNE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2806 FLAMEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2526
Mailing Address - Country:US
Mailing Address - Phone:314-339-7430
Mailing Address - Fax:314-449-9173
Practice Address - Street 1:2806 FLAMEWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2526
Practice Address - Country:US
Practice Address - Phone:314-339-7430
Practice Address - Fax:314-449-9173
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2018-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028576225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist