Provider Demographics
NPI:1295826469
Name:CLAY, PAUL (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CLAY
Suffix:
Gender:M
Credentials:PT
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4520 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3023
Mailing Address - Country:US
Mailing Address - Phone:858-535-1894
Mailing Address - Fax:858-535-1863
Practice Address - Street 1:4520 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3023
Practice Address - Country:US
Practice Address - Phone:858-535-1894
Practice Address - Fax:858-535-1863
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT22895BOtherPPIN
W15730AMedicare ID - Type Unspecified