Provider Demographics
NPI:1740026822
Name:ROLAND, CLAYTON R (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:R
Last Name:ROLAND
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N PARK 40 BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3615
Mailing Address - Country:US
Mailing Address - Phone:865-357-5088
Mailing Address - Fax:
Practice Address - Street 1:465 N PARK 40 BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3615
Practice Address - Country:US
Practice Address - Phone:653-575-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist