Individual
PAUL ALVIN CLAVECILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1099 SOUTH MAIN ST., APT. 314, CROWN POINT, IN 46307
(847) 942-9143
Mailing address
1099 S MAIN ST, APT. 314, CROWN POINT, IN 46307-4851
(847) 942-9143
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
070020612
IL
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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