Provider Demographics
NPI:1063509933
Name:CLAYTON, JAMIE JO (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:JO
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:799 DENISON COURT
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0301
Mailing Address - Country:US
Mailing Address - Phone:248-630-4333
Mailing Address - Fax:248-630-4388
Practice Address - Street 1:799 DENISON COURT
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0301
Practice Address - Country:US
Practice Address - Phone:248-630-4333
Practice Address - Fax:248-630-4388
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011924225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F333640OtherBLUE CROSS BLUE SHIELD
MI650F333640OtherBLUE CROSS BLUE SHIELD