MEDICARE: ERICA LYNNE CLARK PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00006742	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407830359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA LYNNE CLARK PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	7228 W MERCER WAY
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-5572
Country	:	US
Telephone Number	:	206-954-6936
Fax Number	:	206-456-2551

Provider Business Practice Location Address
First Line	:	9311 SE 36TH ST STE 208
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-3741
Country	:	US
Telephone Number	:	206-402-6339
Fax Number	:	206-456-2551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/26/2022

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