Provider Demographics
NPI:1396932570
Name:THOMAS, CLAY KIMBALL (PT)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:KIMBALL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 HUMMINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-5198
Mailing Address - Country:US
Mailing Address - Phone:709-754-4379
Mailing Address - Fax:
Practice Address - Street 1:735 HUMMINGBIRD CT
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5198
Practice Address - Country:US
Practice Address - Phone:709-754-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0053672251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics