Provider Demographics
NPI:1952354029
Name:WEILER, CLAY NORMAN (ATC)
Entity type:Individual
Prefix:MR
First Name:CLAY
Middle Name:NORMAN
Last Name:WEILER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 15TH AVE SE
Mailing Address - Street 2:BFAB 190
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0120
Mailing Address - Country:US
Mailing Address - Phone:612-262-4449
Mailing Address - Fax:612-626-4789
Practice Address - Street 1:516 15TH AVE SE
Practice Address - Street 2:BFAB 190
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0120
Practice Address - Country:US
Practice Address - Phone:612-262-4449
Practice Address - Fax:612-626-4789
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer