Provider Demographics
NPI:1750403820
Name:CLAYPOOL, CARMELA JURADO (PT)
Entity type:Individual
Prefix:MRS
First Name:CARMELA
Middle Name:JURADO
Last Name:CLAYPOOL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:CARMELA
Other - Middle Name:
Other - Last Name:JURADO CLAYPOOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:1044 COOK AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3321
Mailing Address - Country:US
Mailing Address - Phone:651-241-7283
Mailing Address - Fax:
Practice Address - Street 1:333 SMITH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2344
Practice Address - Country:US
Practice Address - Phone:651-241-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4884225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist