Provider Demographics
NPI:1447867304
Name:CINNAMON, CLAY THOMAS (PT)
Entity type:Individual
Prefix:
First Name:CLAY
Middle Name:THOMAS
Last Name:CINNAMON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-0128
Mailing Address - Country:US
Mailing Address - Phone:859-481-5830
Mailing Address - Fax:859-481-9004
Practice Address - Street 1:1113 LINCOLN PARK RD STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-9573
Practice Address - Country:US
Practice Address - Phone:859-481-5830
Practice Address - Fax:859-481-9004
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251E1300X
KY008169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical