Provider Demographics
NPI:1144841651
Name:CLAY SCOLIOSIS CLINIC LLC
Entity type:Organization
Organization Name:CLAY SCOLIOSIS CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:314-744-9264
Mailing Address - Street 1:8515 DELMAR BLVD STE 226
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2197
Mailing Address - Country:US
Mailing Address - Phone:314-744-9264
Mailing Address - Fax:314-474-0118
Practice Address - Street 1:8515 DELMAR BLVD STE 226
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2197
Practice Address - Country:US
Practice Address - Phone:314-744-9264
Practice Address - Fax:314-474-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty