Provider Demographics
NPI:1396214516
Name:NUNLEY, CLAYTON L (PTA)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:L
Last Name:NUNLEY
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 1:267 BUTTERFIELD TRL
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-8434
Mailing Address - Country:US
Mailing Address - Phone:580-380-3326
Mailing Address - Fax:
Practice Address - Street 1:901 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-3640
Practice Address - Country:US
Practice Address - Phone:580-795-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3009225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant