Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251C2600X | Cardiopulmonary | ||
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1841656618 |
---|---|
Provider Name | Clay Ardoin |
First Address | Dolgeville, NY 13329-2904 |
Second Address | Sugar Land, TX 77479-3152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2016 |
Last Update Date | 11/01/2016 |