Provider Demographics
NPI:1134171994
Name:CLEMENT, CHESSON P (PT, MPT)
Entity type:Individual
Prefix:
First Name:CHESSON
Middle Name:P
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODLAND HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1674
Mailing Address - Country:US
Mailing Address - Phone:504-392-7000
Mailing Address - Fax:504-584-7747
Practice Address - Street 1:1455 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1360
Practice Address - Country:US
Practice Address - Phone:203-817-0196
Practice Address - Fax:203-817-0199
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04724225100000X
CT14581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA04724OtherLA PT LICENSE
LA4B616C566Medicare ID - Type UnspecifiedMEDICARE PROVIDER #