Provider Demographics
NPI:1790710713
Name:KLEMENT, RYAN DAVID (PT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:KLEMENT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2114 TEXOMA PKWY
Mailing Address - Street 2:650
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2683
Mailing Address - Country:US
Mailing Address - Phone:903-813-1551
Mailing Address - Fax:903-813-1725
Practice Address - Street 1:2114 TEXOMA PKWY
Practice Address - Street 2:650
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2683
Practice Address - Country:US
Practice Address - Phone:903-813-1551
Practice Address - Fax:903-813-1725
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088979208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
93107Medicare UPIN
TX8B5960Medicare ID - Type Unspecified