Clay Dalton Thebeau, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2021022097 Issued in MO

Practice address

1 College Park Dr
Saint Louis, MO 63141-8660

Phone

(314) 434-1115

NPI assigned

Jul 20, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1154994036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 COLLEGE PARK DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418660",
            "telephone_number": "314-434-1115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLLEGE PARK DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631418660",
            "telephone_number": "314-434-1115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEBEAU",
        "first_name": "CLAY",
        "middle_name": "DALTON",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2021022097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "www.swol123.net",
            "affiliation": "N",
            "address_1": "1 College Park Dr",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631418660",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• The Whiteville Drugstore, LLC
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• The Youthful Body Medical Spa
• The Youthful Body, Inc.
• Tama Saint The, MD
• Clayton E. Thebeau, D.O.
• Kayla Noelle Theberge, LPC
• Heather Theby
• Anne Theiling, PT
• Amber Nicole Theisen

• Athletic Trainer in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.