Basic Information
| Provider Information | |||||||||
| NPI: | 1679197545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLEM | ||||||||
| FirstName: | NATHAN | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3125 S SCATTERFIELD RD STE 130 | ||||||||
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| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460131804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652983500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 N MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652984242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2020 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 05012532A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.