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General NPI Number Information
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NPI Number | 1902075914
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Entity Type | Organization
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Legal Business Name | CLAY PHYSICAL THERAPY PA
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Dates
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Enumeration Date | 02/23/2008
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 1626 SHEFFIELD PL
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City | ORANGE PARK
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State | FL
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Zip | 32073-5268
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Country | US
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Telephone | 904-269-7751
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Fax | 904-278-8552
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | ORANGE PARK
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State | FL
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Zip | 32067-0505
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Country | US
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Telephone | 904-269-7751
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Fax | 904-278-8552
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. LAURIE VALLONE SHIMKO
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Credential | PHYSICAL THERAPIST
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Telephone | 904-269-7751
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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 | PT0014414
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License Number State | FL
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