Provider Demographics
NPI:1093995292
Name:TAYLOR, CLAYTON LLOYD (DPT)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:LLOYD
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 S 500 W
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4320
Mailing Address - Country:US
Mailing Address - Phone:435-650-9903
Mailing Address - Fax:
Practice Address - Street 1:590 E 100 N
Practice Address - Street 2:
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-2640
Practice Address - Country:US
Practice Address - Phone:435-613-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5628646-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT621762357028Medicaid