Provider Demographics
NPI:1467781070
Name:CLAPHAM, PATRICA DIANE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:PATRICA
Middle Name:DIANE
Last Name:CLAPHAM
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 W 5050 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-6709
Mailing Address - Country:US
Mailing Address - Phone:801-814-4072
Mailing Address - Fax:
Practice Address - Street 1:2950 N CHURCH ST STE 102
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-6590
Practice Address - Country:US
Practice Address - Phone:801-547-9462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
UT7752291-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer