Provider Demographics
NPI:1831416445
Name:CURTIS, CLINTON PAUL (LMT)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:PAUL
Last Name:CURTIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 KANE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2524
Mailing Address - Country:US
Mailing Address - Phone:435-459-0343
Mailing Address - Fax:
Practice Address - Street 1:501 KANE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2524
Practice Address - Country:US
Practice Address - Phone:435-459-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5927833-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist