Provider Demographics
NPI:1447828835
Name:MCLEMORE, KEENA S (PTA)
Entity type:Individual
Prefix:MRS
First Name:KEENA
Middle Name:S
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 BARDSEY CT
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28104-0645
Mailing Address - Country:US
Mailing Address - Phone:704-609-8282
Mailing Address - Fax:
Practice Address - Street 1:825 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-7302
Practice Address - Country:US
Practice Address - Phone:704-997-2031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7374225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant