Provider Demographics
NPI:1851908370
Name:CLONCE, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CLONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FOX TRL
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8195
Mailing Address - Country:US
Mailing Address - Phone:865-585-4181
Mailing Address - Fax:
Practice Address - Street 1:644 UNIVERSITY SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2614
Practice Address - Country:US
Practice Address - Phone:859-624-5684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP2020064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist