Provider Demographics
NPI:1902828734
Name:CLEMENT, LYNN M (PT)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 NW 42ND WAY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9220
Mailing Address - Country:US
Mailing Address - Phone:561-789-1251
Mailing Address - Fax:954-571-8637
Practice Address - Street 1:708 NW 42ND WAY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9220
Practice Address - Country:US
Practice Address - Phone:561-789-1251
Practice Address - Fax:954-571-8637
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0684Medicare ID - Type UnspecifiedPROVIDER NUMBER