Provider Demographics
NPI:1821376567
Name:CLEMONS, SHAINA BETH (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SHAINA
Middle Name:BETH
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4704
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-4704
Mailing Address - Country:US
Mailing Address - Phone:410-721-6333
Mailing Address - Fax:410-721-7651
Practice Address - Street 1:2130 PRIEST BRIDGE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2457
Practice Address - Country:US
Practice Address - Phone:410-721-6333
Practice Address - Fax:410-721-7651
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229002YFKMMedicare PIN