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General NPI Number Information
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NPI Number | 1336418508
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Entity Type | Individual
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Provider Name | CLAYTON R WILSON M.S., R.S.C.C.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2011
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Last Update Date | 12/17/2011
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Provider Practice Location Address
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Address Line | 2220 VESTAL RD
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City | VESTAL
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State | NY
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Zip | 13850-1940
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Country | US
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Telephone | 210-380-2671
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 551
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City | ENDICOTT
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State | NY
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Zip | 13761-0551
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Country | US
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Telephone | 210-380-2671
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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 | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number |
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License Number State |
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