Healthcare Provider Details

I. General information

NPI: 1295826469
Provider Name (Legal Business Name): PAUL CLAY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 EXECUTIVE DRIVE SUITE 101
SAN DIEGO CA
92121-3023
US

IV. Provider business mailing address

4520 EXECUTIVE DRIVE SUITE 101
SAN DIEGO CA
92121-3023
US

V. Phone/Fax

Practice location:
  • Phone: 858-535-1894
  • Fax: 858-535-1863
Mailing address:
  • Phone: 858-535-1894
  • Fax: 858-535-1863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: