Provider Demographics
NPI:1841523289
Name:CLEARWATER, EDWARD C (DPT)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:CLEARWATER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3131
Mailing Address - Country:US
Mailing Address - Phone:845-565-5054
Mailing Address - Fax:845-565-4071
Practice Address - Street 1:260 NORTH ST
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3131
Practice Address - Country:US
Practice Address - Phone:845-565-5054
Practice Address - Fax:845-565-4071
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031868-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q2WKL1Medicare PIN