Provider Demographics
NPI:1154596377
Name:CLAYTON, JESSICA MARLING (DPT)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:MARLING
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4616 HIGHWAY 84 W
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-3357
Mailing Address - Country:US
Mailing Address - Phone:318-336-5400
Mailing Address - Fax:318-336-8621
Practice Address - Street 1:4616 HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-3357
Practice Address - Country:US
Practice Address - Phone:318-336-5400
Practice Address - Fax:318-336-8621
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09009R2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA236280Medicaid