Individual
JACK CLIFTON CLANTON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5455 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7711
(325) 942-4000
(325) 944-9571
Mailing address
5455 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7711
(325) 942-4000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2037349
TX
Other
Enumeration date
08/23/2018
Last updated
08/23/2018
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