Provider Demographics
NPI:1457148942
Name:CLAXTON, BRALEY RAE (PTA)
Entity type:Individual
Prefix:
First Name:BRALEY
Middle Name:RAE
Last Name:CLAXTON
Suffix:
Gender:
Credentials:PTA
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 173
Mailing Address - Street 2:
Mailing Address - City:DOUGHERTY
Mailing Address - State:OK
Mailing Address - Zip Code:73032-0173
Mailing Address - Country:US
Mailing Address - Phone:580-490-2299
Mailing Address - Fax:
Practice Address - Street 1:2011 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4221
Practice Address - Country:US
Practice Address - Phone:580-622-2161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3864225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant