Provider Demographics
NPI:1497142806
Name:PAINE, CLIFTON (PTA)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:
Last Name:PAINE
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 1:420 PR 1380
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:TX
Mailing Address - Zip Code:76671-3230
Mailing Address - Country:US
Mailing Address - Phone:254-998-0159
Mailing Address - Fax:
Practice Address - Street 1:420 PR 1380
Practice Address - Street 2:
Practice Address - City:MORGAN
Practice Address - State:TX
Practice Address - Zip Code:76671-3230
Practice Address - Country:US
Practice Address - Phone:254-998-0159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1127225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant