Provider Demographics
NPI:1063924132
Name:CLAY, PATRICIA A (LMP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CLAY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:A
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2121 W 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-4316
Mailing Address - Country:US
Mailing Address - Phone:509-455-9970
Mailing Address - Fax:
Practice Address - Street 1:2121 W. 13TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-4316
Practice Address - Country:US
Practice Address - Phone:509-455-9970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00003049225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist