Provider Demographics
NPI:1588790133
Name:CLEMENTS, JAMES JR (PT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CLEMENTS
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08035-1901
Mailing Address - Country:US
Mailing Address - Phone:856-546-0377
Mailing Address - Fax:
Practice Address - Street 1:135 E ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1901
Practice Address - Country:US
Practice Address - Phone:856-546-0377
Practice Address - Fax:856-546-0399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00472300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085805Medicare ID - Type UnspecifiedINDIVIDUAL