Provider Demographics
NPI:1114317641
Name:WIELARD, CLAY (DPT)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:
Last Name:WIELARD
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 1:3737 BRITTON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9716
Mailing Address - Country:US
Mailing Address - Phone:517-625-0772
Mailing Address - Fax:517-625-0778
Practice Address - Street 1:3737 BRITTON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9716
Practice Address - Country:US
Practice Address - Phone:517-625-0772
Practice Address - Fax:517-625-0778
Is Sole Proprietor?:No
Enumeration Date:2015-02-05
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010168742251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic