Provider Demographics
NPI:1265952881
Name:CLEMSON ENTERPRISE PLLC
Entity type:Organization
Organization Name:CLEMSON ENTERPRISE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:CLEMSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:423-212-5966
Mailing Address - Street 1:444 CLINCHFIELD ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3859
Mailing Address - Country:US
Mailing Address - Phone:678-978-2395
Mailing Address - Fax:423-212-7046
Practice Address - Street 1:444 CLINCHFIELD ST STE 102
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3859
Practice Address - Country:US
Practice Address - Phone:678-978-2395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-24
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty