Healthcare Provider Details

I. General information

NPI: 1710326129
Provider Name (Legal Business Name): JONI J CLAYTON RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 N 1ST ST.
HOTCHKISS CO
81419
US

IV. Provider business mailing address

PO BOX 292
PAONIA CO
81428-0292
US

V. Phone/Fax

Practice location:
  • Phone: 970-260-4058
  • Fax:
Mailing address:
  • Phone: 970-260-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0014687
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: