MEDICARE: KEITHA D CLAYTON PT

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	225100000X	Physical Therapist	104779	TX

General Provider Information

NPI Number	:	1932228244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITHA D CLAYTON PT

Provider Business Mailing Address
First Line	:	720 COOL SPRINGS BLVD
Second Line	:	SUITE 300
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2626
Country	:	US
Telephone Number	:	615-778-4066
Fax Number	:	615-778-9114

Provider Business Practice Location Address
First Line	:	1904 GRANDSTAND DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78238-4508
Country	:	US
Telephone Number	:	615-778-4066
Fax Number	:	615-778-9114

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/08/2007

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