Provider Demographics
NPI:1053400184
Name:CLARY, DUSTIN M (RPT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:M
Last Name:CLARY
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MCFARLAND BLVD NE
Mailing Address - Street 2:STE 150
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2283
Mailing Address - Country:US
Mailing Address - Phone:205-758-9041
Mailing Address - Fax:
Practice Address - Street 1:1825 MCFARLAND BLVD N
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2251
Practice Address - Country:US
Practice Address - Phone:205-752-1650
Practice Address - Fax:205-752-1657
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 2715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL522381365OtherTAX ID
AL051531512OtherBLUE CROSS PROVIDER #
AL412166803OtherTAX ID
AL051518450OtherBLUE CROSS PROVIDER #