Provider Demographics
NPI:1891752432
Name:CLAWSON, DAVID (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 FULTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4275
Mailing Address - Country:US
Mailing Address - Phone:916-488-4000
Mailing Address - Fax:916-488-4005
Practice Address - Street 1:1075 FULTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4275
Practice Address - Country:US
Practice Address - Phone:916-488-4000
Practice Address - Fax:916-488-4005
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT174840Medicare ID - Type UnspecifiedPHYSICAL THERAPIST