Provider Demographics
NPI:1497712251
Name:CLINTON, GARY DEAN (AT,C)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:CLINTON
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9214 STONECREST RD NE
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-9341
Mailing Address - Country:US
Mailing Address - Phone:509-762-6476
Mailing Address - Fax:
Practice Address - Street 1:803 SHARON AVE E
Practice Address - Street 2:MOSES LAKE HIGH SCHOOL
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2441
Practice Address - Country:US
Practice Address - Phone:509-766-2666
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer