Healthcare Provider Details

I. General information

NPI: 1346304615
Provider Name (Legal Business Name): PATRICK NOEL CLOUGH PT CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 SOUTH RD
POUGHKEEPSIE NY
12601-1260
US

IV. Provider business mailing address

1890 SOUTH RD
POUGHKEEPSIE NY
12601-6028
US

V. Phone/Fax

Practice location:
  • Phone: 845-632-6775
  • Fax:
Mailing address:
  • Phone: 845-632-6775
  • Fax: 845-632-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number1041100058
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: