Provider Demographics
NPI:1306564265
Name:CLAY, AMELIA (PT, DPT)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SOMMERSBY LN
Mailing Address - Street 2:
Mailing Address - City:TROUTVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24175-6947
Mailing Address - Country:US
Mailing Address - Phone:540-986-6239
Mailing Address - Fax:
Practice Address - Street 1:1110 VINYARD RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-3632
Practice Address - Country:US
Practice Address - Phone:540-343-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215174225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist