Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 36462 | CA |
NPI | 1194048363 |
---|---|
Provider Name | Mr. Thomas L Clennell |
First Address | Walnut Creek, CA 94598-5988 |
Second Address | Walnut Creek, CA 94598-5988 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2010 |
Last Update Date | 03/03/2010 |