Provider Demographics
NPI:1538835483
Name:CLAWSON, PHILIP CLAYTON
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:CLAYTON
Last Name:CLAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WOODLAND HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-1674
Mailing Address - Country:US
Mailing Address - Phone:504-392-7000
Mailing Address - Fax:504-584-7747
Practice Address - Street 1:1610 BELLE CHASSE HWY
Practice Address - Street 2:
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-7056
Practice Address - Country:US
Practice Address - Phone:504-362-1000
Practice Address - Fax:504-584-7747
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10976225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist