Provider Demographics
NPI:1629233804
Name:ASTLE, CLINTON LEE (MPT)
Entity Type:Individual
Prefix:MR
First Name:CLINTON
Middle Name:LEE
Last Name:ASTLE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 E GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-5148
Mailing Address - Country:US
Mailing Address - Phone:928-925-0462
Mailing Address - Fax:
Practice Address - Street 1:3108 CLEARWATER DR
Practice Address - Street 2:ST B2
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7170
Practice Address - Country:US
Practice Address - Phone:928-777-9890
Practice Address - Fax:928-777-9891
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist