Provider Demographics
NPI:1205238557
Name:CLIFFORD, JANET (PT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CLIFFORD
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 1:8791 CHANDLER DR APT B
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-4868
Mailing Address - Country:US
Mailing Address - Phone:843-446-5705
Mailing Address - Fax:
Practice Address - Street 1:8791 CHANDLER DR APT B
Practice Address - Street 2:
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-4868
Practice Address - Country:US
Practice Address - Phone:843-446-5705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1544225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist