Individual
MR. CLYDE GLENN GORDON DOROMAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT, PTRP
Contact information
Practice address
400 MAPLE VALLEY DR, PANG APARTMENT 17, FARMINGTON, MO 63640-1973
(870) 329-1625
Mailing address
400 MAPLE VALLEY DR, PANG APARTMENT 17, FARMINGTON, MO 63640-1979
(870) 329-1625
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2006010374
MO
225100000X
Physical Therapist
—
IL
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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