Healthcare Provider Details

I. General information

NPI: 1922749530
Provider Name (Legal Business Name): CLYDE SINGLETON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HOSPITAL LOOP NE
ALBUQUERQUE NM
87109-2115
US

IV. Provider business mailing address

9001 MAJOR AVE
MORTON GROVE IL
60053-2535
US

V. Phone/Fax

Practice location:
  • Phone: 505-348-8300
  • Fax:
Mailing address:
  • Phone: 224-616-7675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.010299
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPT-2026-0258
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: