Provider Demographics
NPI:1992816961
Name:CLAYPOOL, JAY DAVID (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:DAVID
Last Name:CLAYPOOL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1429 FLUSHING RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-2228
Practice Address - Country:US
Practice Address - Phone:810-487-9128
Practice Address - Fax:810-487-9178
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501006952225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30439OtherBLUE CROSS
MI30439OtherBLUE CROSS
MIN69750033Medicare PIN