Organization
CLAY PHYSICAL THERAPY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE VALLONE SHIMKO PHYSICAL THERAPIST (OWNER/PRESIDENT)
(904) 269-7751
Entity
Organization
Contact information
Practice address
1626 SHEFFIELD PL, ORANGE PARK, FL 32073-5268
(904) 269-7751
(904) 278-8552
Mailing address
PO BOX 505, ORANGE PARK, FL 32067-0505
(904) 269-7751
(904) 278-8552
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT0014414
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
678795996
MEDWAIVER
FL
05
—
885134400
—
FL
01
—
E1907A
MEDICARE INDIVIDUAL
FL
Enumeration date
02/23/2008
Last updated
10/05/2011
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