Provider Demographics
NPI:1952379596
Name:CLEMENT, TANYA L (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:L
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:L
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:897 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1029
Mailing Address - Country:US
Mailing Address - Phone:207-564-4273
Mailing Address - Fax:207-564-4274
Practice Address - Street 1:897 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1029
Practice Address - Country:US
Practice Address - Phone:207-564-4273
Practice Address - Fax:207-564-4274
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME189660000Medicaid
ME432033799Medicaid
ME061551OtherANTHEM
ME061551OtherANTHEM
ME206513Medicare ID - Type Unspecified
ME2124Medicare PIN