Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | PT31658 | FL |
NPI | 1043763501 |
---|---|
Provider Name | Clayton Piez |
First Address | Davie, FL 33328-1473 |
Second Address | Boynton Beach, FL 33436-4613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2016 |
Last Update Date | 01/08/2016 |