Provider Demographics
NPI:1356685853
Name:CLAYTON, JOE (PTA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 NORTH OCEAN BLVD
Mailing Address - Street 2:19E
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:410-963-8621
Mailing Address - Fax:
Practice Address - Street 1:3001 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1806
Practice Address - Country:US
Practice Address - Phone:754-212-1870
Practice Address - Fax:954-566-0293
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3670225200000X
FL23697225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant