Provider Demographics
NPI:1316481484
Name:CLEWELL, KERRY ALAN (ATC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ALAN
Last Name:CLEWELL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 S US HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-2611
Mailing Address - Country:US
Mailing Address - Phone:251-580-3232
Mailing Address - Fax:
Practice Address - Street 1:1512 S US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-2611
Practice Address - Country:US
Practice Address - Phone:251-580-3232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17362255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer