Individual
MARNIE CLEMENS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
306 W MAIN ST, BRIDGEPORT, WV 26330-1751
(304) 842-3137
(304) 842-3138
Mailing address
104 ORCHARD AVE, BRIDGEPORT, WV 26330-1736
(304) 842-6008
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001091
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01071873100
WORKERS' COMPENSATION
WV
01
—
010718731002
BC/BS
WV
05
—
0157976001
—
WV
01
—
1382862
UMWA
WV
01
—
398791
OPTIMUM CHOICE
WV
01
—
650023876
RAILRAOD MEDICARE
WV
01
—
7508068
AETNA
WV
01
—
79582
HEALTH ASSURANCE
WV
01
—
WV51916B
HEALTH PLAN
WV
Enumeration date
06/02/2005
Last updated
09/15/2017
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