Individual
MISS KERI RENEE CLAYBOURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
005470
KY
225100000X
Physical Therapist
Primary
05009722A
IN
225100000X
Physical Therapist
2006006324
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000602229
BLUE CROSS AND BLUE SHIELD
IN
01
—
000000607010
BLUE CROSS AND BLUE SHIELD
IN
05
—
200935970
—
IN
Enumeration date
05/10/2006
Last updated
01/07/2011
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