Healthcare Provider Details

I. General information

NPI: 1295710259
Provider Name (Legal Business Name): CLAY ALAN REID PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 4TH AVE
PASCO WA
99301-5257
US

IV. Provider business mailing address

520 N 4TH AVE
PASCO WA
99301-5257
US

V. Phone/Fax

Practice location:
  • Phone: 509-547-7704
  • Fax:
Mailing address:
  • Phone: 509-547-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00009475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: