Provider Demographics
NPI:1487303640
Name:PAWLEY, CLIFF E (ATC)
Entity type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:E
Last Name:PAWLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNIVERSITY PLAZA PARKER 215C
Mailing Address - Street 2:SOUTHEAST MISSOURI STATE UNIVERSITY
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4710
Mailing Address - Country:US
Mailing Address - Phone:949-295-7750
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY PLAZA PARKER 215C
Practice Address - Street 2:SOUTHEAST MISSOURI STATE UNIVERSITY
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4710
Practice Address - Country:US
Practice Address - Phone:949-295-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210484632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer