Provider Demographics
NPI:1699463372
Name:CLYDE-CORRENTI, ELENA (PT)
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:CLYDE-CORRENTI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:
Other - Last Name:CORRENTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:26415 BUOY CT
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-7303
Mailing Address - Country:US
Mailing Address - Phone:516-849-2541
Mailing Address - Fax:
Practice Address - Street 1:26415 BUOY CT
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-7303
Practice Address - Country:US
Practice Address - Phone:516-849-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0014508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist