Provider Demographics
NPI:1801950274
Name:DAVIS, CLAYTON SCOTT (LPTA)
Entity type:Individual
Prefix:MR
First Name:CLAYTON
Middle Name:SCOTT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31037 SECRETARIAT TRL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-9681
Mailing Address - Country:US
Mailing Address - Phone:352-360-0688
Mailing Address - Fax:
Practice Address - Street 1:700 N PALMETTO ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4419
Practice Address - Country:US
Practice Address - Phone:352-323-5636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA-015664225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant