Provider Demographics
NPI:1184993966
Name:CLEM, DIANN M (DPT)
Entity type:Individual
Prefix:
First Name:DIANN
Middle Name:M
Last Name:CLEM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DIANN
Other - Middle Name:M
Other - Last Name:BEUTHIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 43RD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8401
Mailing Address - Country:US
Mailing Address - Phone:309-743-2070
Mailing Address - Fax:309-743-2073
Practice Address - Street 1:4439 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4549
Practice Address - Country:US
Practice Address - Phone:309-743-0106
Practice Address - Fax:309-743-0108
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018971225100000X
IA004932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist