Provider Demographics
NPI:1487809679
Name:CLARKIN, JANELLE COLLEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:COLLEEN
Last Name:CLARKIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 WILLOWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-6332
Mailing Address - Country:US
Mailing Address - Phone:941-405-9690
Mailing Address - Fax:941-749-7610
Practice Address - Street 1:9020 WILLOWBROOK CIR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-6332
Practice Address - Country:US
Practice Address - Phone:315-794-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24671225100000X
FLPT 246712251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003146127OtherNPI
FL001218700Medicaid
FL001735200Medicaid
FLY09RMOtherFLORIDA BLUE