Provider Demographics
NPI:1871740258
Name:CLEMMONS, AMY JAVON (PTA)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:JAVON
Last Name:CLEMMONS
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 1:1756 ZAHNS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9755
Mailing Address - Country:US
Mailing Address - Phone:740-289-1699
Mailing Address - Fax:
Practice Address - Street 1:1756 ZAHNS CORNER RD
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9755
Practice Address - Country:US
Practice Address - Phone:740-289-1699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50189225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant