Provider Demographics
NPI:1336418508
Name:WILSON, CLAYTON R (MS, RSCC)
Entity Type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:MS, RSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 551
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13761-0551
Mailing Address - Country:US
Mailing Address - Phone:210-380-2671
Mailing Address - Fax:
Practice Address - Street 1:2220 VESTAL RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1940
Practice Address - Country:US
Practice Address - Phone:210-380-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2011-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist