Basic Information
| Provider Information | |||||||||
| NPI: | 1578598207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAYTON | ||||||||
| FirstName: | DELEANA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1736 GUNBARREL RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238949893 | ||||||||
| FaxNumber: | 4238940992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1736 GUNBARREL RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374213127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4238949893 | ||||||||
| FaxNumber: | 4238940992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT3409 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.