MEDICARE: JOE CLAYTON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	3670	MD
2	225200000X	Physical Therapy Assistant	23697	FL

General Provider Information

NPI Number	:	1356685853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE CLAYTON PTA

Provider Business Mailing Address
First Line	:	3015 NORTH OCEAN BLVD
Second Line	:	19E
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308
Country	:	US
Telephone Number	:	410-963-8621
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 E OAKLAND PARK BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1806
Country	:	US
Telephone Number	:	754-212-1870
Fax Number	:	954-566-0293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2012
Last Update Date	:	03/17/2018

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Directions to “ JOE CLAYTON PTA” Practice Location

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