Individual
MARY C CLEMMENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4502 MILWAUKEE ST, MADISON, WI 53714-2133
(608) 249-2137
Mailing address
S2261 YELLOW THUNDER TRL, BARABOO, WI 53913-9356
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
219
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40323400
—
WI
Enumeration date
03/27/2007
Last updated
11/08/2012
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