Provider Demographics
NPI:1093857559
Name:CLAY, JACLYN LEANN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:LEANN
Last Name:CLAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:628 COUNTY ROAD 782
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7727
Mailing Address - Country:US
Mailing Address - Phone:870-910-5031
Mailing Address - Fax:870-240-8505
Practice Address - Street 1:1910 RECTOR RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2004
Practice Address - Country:US
Practice Address - Phone:870-240-8500
Practice Address - Fax:870-240-8505
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 2805225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist