Provider Demographics
NPI:1720485576
Name:HOOTEN, CLAUDE III
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:
Last Name:HOOTEN
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1036
Mailing Address - Country:US
Mailing Address - Phone:727-461-7041
Mailing Address - Fax:
Practice Address - Street 1:641 1/2 MANDALAY AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33767-1523
Practice Address - Country:US
Practice Address - Phone:727-461-7041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44381225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist