Doctor Name: | MR. WILLIS K CLYDE |
NPI Number: | 1033293865 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.T. |
License Number: | 117343-2401 |
Business Practice Address: | 190 N Main St Heber City, UT - 840321600 |
Business Phone Number: | 4356540804 |
Business Fax Number: | 4356543314 |
Mailing Address: | Po Box 13, HEBER CITY |
State: | UT |
Postal Code: | 840320013 |
Phone Number: | 4356540804 |
Fax Number: | 4356543314 |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 04/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 117343-2401 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |