Basic Information
| Provider Information | |||||||||
| NPI: | 1386867075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWEY | ||||||||
| FirstName: | CLARA | ||||||||
| MiddleName: | YVONNE | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9812 SUNNYSIDE RD | ||||||||
| Address2: | |||||||||
| City: | BRIDGEVILLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199334702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023373601 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 MIDDLEFORD RD | ||||||||
| Address2: | |||||||||
| City: | SEAFORD | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199733636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026296611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0000275 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.