Provider Demographics
NPI:1194790501
Name:CLEMENTS, MELANIE R (PT)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:R
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1306 W COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2502
Mailing Address - Country:US
Mailing Address - Phone:870-642-4990
Mailing Address - Fax:870-642-7250
Practice Address - Street 1:1306 W. COLLIN RAYE DR.
Practice Address - Street 2:
Practice Address - City:DEQUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832
Practice Address - Country:US
Practice Address - Phone:870-642-4990
Practice Address - Fax:870-642-7250
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142772721Medicaid
AR142772721Medicaid