Provider Demographics
NPI:1518417047
Name:BRACKETT, CLAY THOMAS (PTA)
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:THOMAS
Last Name:BRACKETT
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 1:1 LAURELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9485
Mailing Address - Country:US
Mailing Address - Phone:828-273-3644
Mailing Address - Fax:
Practice Address - Street 1:1 LAURELWOOD DR
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9485
Practice Address - Country:US
Practice Address - Phone:828-273-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4687225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant