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General NPI Number Information
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NPI Number | 1275968695
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Entity Type | Individual
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Provider Name | CLAYTON HAGUE PT
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Gender | Male
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Dates
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Enumeration Date | 09/04/2013
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 4300 MARKET POINTE DR
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5423
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Country | US
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Telephone | 952-769-1684
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 MARKET POINTE DR
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City | BLOOMINGTON
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State | MN
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Zip | 55435-5423
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Country | US
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Telephone | 952-769-1684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9251
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4222
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License Number State | OR
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