Provider Demographics
NPI:1972998821
Name:CLAYMOTH LLC
Entity Type:Organization
Organization Name:CLAYMOTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SWATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTHKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-267-1996
Mailing Address - Street 1:1101 CUMBERLAND XING
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2356
Mailing Address - Country:US
Mailing Address - Phone:219-267-1996
Mailing Address - Fax:
Practice Address - Street 1:1101 CUMBERLAND XING
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2356
Practice Address - Country:US
Practice Address - Phone:219-267-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062446A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty