Provider Demographics
NPI:1770684698
Name:CLAYTON, BRUCE GARY
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:GARY
Last Name:CLAYTON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:BRUCE
Other - Middle Name:GARY
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:13575 NE 54TH PL
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-1037
Mailing Address - Country:US
Mailing Address - Phone:206-722-2205
Mailing Address - Fax:206-722-5457
Practice Address - Street 1:3207 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-6031
Practice Address - Country:US
Practice Address - Phone:206-722-2205
Practice Address - Fax:206-722-5457
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5632526OtherAETNA
WAG8334427Medicaid
WACL3893OtherREGENCE
WA0038316OtherWASHINGTON STATE L & I
WA8918109OtherWASHINGTON STATE CRIME V
WA0038316OtherWASHINGTON STATE L & I