Provider Demographics
NPI:1992941512
Name:STATON, CLARKE (CMT)
Entity type:Individual
Prefix:MR
First Name:CLARKE
Middle Name:
Last Name:STATON
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-5010
Mailing Address - Country:US
Mailing Address - Phone:540-414-3211
Mailing Address - Fax:
Practice Address - Street 1:1105 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5010
Practice Address - Country:US
Practice Address - Phone:540-414-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-02
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA26-1363486225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist