Individual
MRS. ROBERTA K CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
25 MICHIGAN ST NE STE 3300, GRAND RAPIDS, MI 49503-2558
(616) 459-4171
(616) 459-0044
Mailing address
25 MICHIGAN ST NE STE 3300, GRAND RAPIDS, MI 49503-2558
(616) 459-4171
(616) 459-0044
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002660
MICHIGAN LICENSE
MI
Enumeration date
10/02/2006
Last updated
03/14/2013
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