MEDICARE: CLAYTON PIEZ P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	PT31658	FL

General Provider Information

NPI Number	:	1043763501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAYTON PIEZ P.T.

Provider Business Mailing Address
First Line	:	2640 S UNIVERSITY DR
Second Line	:	APT 107
City	:	DAVIE
State	:	FL
Zip	:	33328-1473
Country	:	US
Telephone Number	:	813-598-4322
Fax Number	:

Provider Business Practice Location Address
First Line	:	3111 W BOYNTON BEACH BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-4613
Country	:	US
Telephone Number	:	561-742-3283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	08/01/2016

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