Provider Demographics
NPI:1275968695
Name:HAGUE, CLAYTON (PT)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:HAGUE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 MARKET POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5423
Mailing Address - Country:US
Mailing Address - Phone:952-769-1684
Mailing Address - Fax:
Practice Address - Street 1:4300 MARKET POINTE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5423
Practice Address - Country:US
Practice Address - Phone:952-769-1684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9251225100000X
OR4222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist