Provider Demographics
NPI:1124793534
Name:CLAYBAUGH, PATRICK VINCENT JR (PT, DPT, TSAC-F)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:VINCENT
Last Name:CLAYBAUGH
Suffix:JR
Gender:M
Credentials:PT, DPT, TSAC-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-2160
Mailing Address - Country:US
Mailing Address - Phone:724-550-3726
Mailing Address - Fax:
Practice Address - Street 1:210 VILLAGE CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-6706
Practice Address - Country:US
Practice Address - Phone:843-286-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist