Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2909 | OR |
N | 2251N0400X | Physical Therapist - Neurology | 2909 | OR |
N | 2251X0800X | Physical Therapist - Orthopedic | 2909 | OR |
NPI | 1316016082 |
---|---|
Provider Name | Raleigh B Clough |
First Address | Lincoln City, OR 97367-3652 |
Second Address | Lincoln City, OR 97367-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 01/12/2009 |