Provider Demographics
NPI:1972092005
Name:CLAYTON, JOHN GREGORY (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GREGORY
Last Name:CLAYTON
Suffix:
Gender:M
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 1:5345 TWIN BRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6843
Mailing Address - Country:US
Mailing Address - Phone:812-525-8315
Mailing Address - Fax:
Practice Address - Street 1:1093 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2252
Practice Address - Country:US
Practice Address - Phone:303-655-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.00119172251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic