Provider Demographics
NPI:1861710659
Name:CLEMENTS, MARTHA MARY (PT)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:MARY
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:25117 SW PARKWAY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:888-757-3422
Mailing Address - Fax:877-282-1880
Practice Address - Street 1:511 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SHOSHONE
Practice Address - State:ID
Practice Address - Zip Code:83352-5380
Practice Address - Country:US
Practice Address - Phone:208-886-2549
Practice Address - Fax:208-886-2228
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist