Provider Demographics
NPI:1902184351
Name:COUNTS, CLAYTON (PTA)
Entity Type:Individual
Prefix:
First Name:CLAYTON
Middle Name:
Last Name:COUNTS
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 1:4010 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-0720
Mailing Address - Country:US
Mailing Address - Phone:870-530-3693
Mailing Address - Fax:870-933-9293
Practice Address - Street 1:3114 FOX RD
Practice Address - Street 2:SUITE A
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9322
Practice Address - Country:US
Practice Address - Phone:870-530-3693
Practice Address - Fax:870-933-9293
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA2505225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant