Provider Demographics
NPI:1053428151
Name:KORN, CLIFFORD W (LMT)
Entity type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:W
Last Name:KORN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 INDIAN ROCK ROAD
Mailing Address - Street 2:WINDHAM HEALTH CENTER
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-1656
Mailing Address - Country:US
Mailing Address - Phone:603-894-6402
Mailing Address - Fax:
Practice Address - Street 1:87 INDIAN ROCK ROAD
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1656
Practice Address - Country:US
Practice Address - Phone:603-894-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH692M225700000X
FLMA38765225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist