Provider Demographics
NPI:1588935605
Name:RADLIFF, CLAIR JOHANNA
Entity type:Individual
Prefix:MS
First Name:CLAIR
Middle Name:JOHANNA
Last Name:RADLIFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 S 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17103-1916
Mailing Address - Country:US
Mailing Address - Phone:302-358-7380
Mailing Address - Fax:
Practice Address - Street 1:810 BELLAIRE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-9045
Practice Address - Country:US
Practice Address - Phone:903-589-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant