Provider Demographics
NPI:1952777633
Name:DODSON, CLAY WALTER (PT)
Entity type:Individual
Prefix:DR
First Name:CLAY
Middle Name:WALTER
Last Name:DODSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7799 WOODBURY PIKE
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1141
Mailing Address - Country:US
Mailing Address - Phone:814-729-7021
Mailing Address - Fax:814-729-7068
Practice Address - Street 1:7799 WOODBURY PIKE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1141
Practice Address - Country:US
Practice Address - Phone:814-729-7021
Practice Address - Fax:814-729-7068
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist