Provider Demographics
NPI:1851027155
Name:DENSMORE, CLAY ROBERT (DPT)
Entity Type:Individual
Prefix:DR
First Name:CLAY
Middle Name:ROBERT
Last Name:DENSMORE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21155 N 56TH ST APT 3122
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5556
Mailing Address - Country:US
Mailing Address - Phone:440-417-3757
Mailing Address - Fax:
Practice Address - Street 1:20240 N 78TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6198
Practice Address - Country:US
Practice Address - Phone:480-386-8964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30052225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ30052OtherARIZONA STATE BOARD OF PHYSICAL THERAPY