Provider Demographics
NPI:1588144919
Name:LABUS, CLAYTON VINCENT
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:VINCENT
Last Name:LABUS
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 1:4103 N LOOP 1604 W STE 213
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4160
Mailing Address - Country:US
Mailing Address - Phone:210-423-3034
Mailing Address - Fax:210-764-0184
Practice Address - Street 1:4103 N LOOP 1604 W STE 213
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4160
Practice Address - Country:US
Practice Address - Phone:210-423-3034
Practice Address - Fax:210-764-0184
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1310065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist