Provider Demographics
NPI:1982655742
Name:MCCLEMONS, CAROLINE (MPT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:MCCLEMONS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 NEWCASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CARDIFF
Mailing Address - State:CA
Mailing Address - Zip Code:92007-1762
Mailing Address - Country:US
Mailing Address - Phone:760-230-5432
Mailing Address - Fax:
Practice Address - Street 1:2041 NEWCASTLE AVE
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1762
Practice Address - Country:US
Practice Address - Phone:760-230-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFJ9518OtherMEDICARE PTAN