Active NPI
Clayton Self, PT
- Physical Therapist
- Williamston, NC
National Provider Identifier
1689082927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- P15099
- Practice address
- 310 S McCaskey Rd
Williamston, NC 27892-2150 - Phone
- (252) 809-6300
- NPI assigned
- Jul 31, 2014
- Last updated
- Jul 31, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | P15099 | NC | Primary |
Addresses
Primary practice location
310 S McCaskey Rd
Williamston, NC 27892-2150
Mailing address
1805B Summerhaven Dr
Greenville, NC 27858-6082
Phone (252) 312-7250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15099 | NC | MD | Occupational Therapy Assistant |
| P15099 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1406764800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1406764800000",
"number": "1689082927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1805B SUMMERHAVEN DR",
"city": "GREENVILLE",
"state": "NC",
"postal_code": "278586082",
"telephone_number": "252-312-7250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 S MCCASKEY RD",
"city": "WILLIAMSTON",
"state": "NC",
"postal_code": "278922150",
"telephone_number": "252-809-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELF",
"first_name": "CLAYTON",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-31",
"last_updated": "2014-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "P15099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Williamston, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.