Provider Demographics
NPI:1659367126
Name:CLEMMER, CORI E (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CORI
Middle Name:E
Last Name:CLEMMER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 SCHOENERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7307
Mailing Address - Country:US
Mailing Address - Phone:610-861-8080
Mailing Address - Fax:
Practice Address - Street 1:2775 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7307
Practice Address - Country:US
Practice Address - Phone:610-861-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017212225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1673339OtherBLUE SHIELD
PA088435EDCMedicare ID - Type Unspecified
PA1673339OtherPERSONAL CHOICE
PA2002080OtherKEYSTONE CENTRAL
PA7389740OtherAETNA