Provider Demographics
NPI:1922522473
Name:MORRIS, CLINTON WAYNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:WAYNE
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 GRANT LINE RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2399
Mailing Address - Country:US
Mailing Address - Phone:812-944-1377
Mailing Address - Fax:812-944-1458
Practice Address - Street 1:3626 GRANT LINE RD STE 105
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2399
Practice Address - Country:US
Practice Address - Phone:812-944-1377
Practice Address - Fax:812-944-1458
Is Sole Proprietor?:No
Enumeration Date:2017-07-26
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05012537A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist