Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-012599 | OH |
N | 2251E1200X | Ergonomics | PT-012599 | OH |
N | 225XE1200X | Ergonomics | PT-012599 | OH |
N | 2251G0304X | Physical Therapist - Geriatrics | PT-012599 | |
N | 2251H1200X | Hand | PT-012599 | OH |
N | 2251H1300X | Human Factors | PT-012599 | OH |
N | 225XH1300X | Human Factors | PT-012599 | OH |
N | 2251S0007X | Physical Therapist - Sports | PT-012599 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-012599 | OH |
NPI | 1912230509 |
---|---|
Provider Name | Eric Martin Clevidence |
First Address | Columbus, OH 43213-4491 |
Second Address | Hilliard, OH 43026-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2009 |
Last Update Date | 16/04/2021 |