Provider Demographics
NPI:1295973626
Name:CLAY, CHARLES EDWARD II (DPT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:CLAY
Suffix:II
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 1:2386 E DEL MAR BLVD
Mailing Address - Street 2:#104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4720
Mailing Address - Country:US
Mailing Address - Phone:626-806-7513
Mailing Address - Fax:626-795-0706
Practice Address - Street 1:2386 E DEL MAR BLVD
Practice Address - Street 2:#104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4720
Practice Address - Country:US
Practice Address - Phone:626-806-7513
Practice Address - Fax:626-795-0706
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 25488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist