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NPI Code Detail

MEDICARE: MR. CLAY THOMAS BALES DPT

MEDICARE: MR. CLAY THOMAS BALES DPT
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
1225100000XPhysical TherapistPT24950FL

General Provider Information

NPI Number : 1699908061
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CLAY THOMAS BALES DPT
Provider Business Mailing Address
First Line : 130 OLD TOWN PKWY UNIT 2103
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32084-5828
Country : US
Telephone Number : 904-392-5820
Fax Number :
Provider Business Practice Location Address
First Line : 6248 103RD ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32210-7733
Country : US
Telephone Number : 904-573-0046
Fax Number : 904-573-0772
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2009
Last Update Date : 09/01/2009

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Directions to “ MR. CLAY THOMAS BALES DPT” Practice Location

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