MR. Clyde Glenn Gordon Doromal, RPT, PTRP

NPI #1457562357 in Farmington, Missouri

Provider Information

NPI Number: 1457562357
Entity Type: Individual
Name: MR. Clyde Glenn Gordon Doromal, RPT, PTRP
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Credential: RPT, PTRP
Enumeration Date: May 24, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 400 MAPLE VALLEY DR
Address 2: PANG APARTMENT 17
City: Farmington
State: Missouri
ZIP Code: 63640-1973
Phone: (870) 329-1625

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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