Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 4397-24 | WI |
N | 2251P0200X | Physical Therapist - Pediatrics | 4397-24 | WI |
NPI | 1124041918 |
---|---|
Provider Name | Valerie Clevenger |
First Address | Madison, WI 53704-3260 |
Second Address | Madison, WI 53704-3260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4397-24 | PT PEDIATRICS (01) | WI |