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NPI Code Detail

MEDICARE: NICOLE CLARK PT

MEDICARE: NICOLE CLARK PT
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
1225100000XPhysical TherapistTN
2225100000XPhysical Therapist13616TN

General Provider Information

NPI Number : 1700466521
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE CLARK PT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-497-0005
Fax Number :
Provider Business Practice Location Address
First Line : 2600 TAFT HWY STE 400
Second Line :
City : SIGNAL MOUNTAIN
State : TN
Zip : 37377-2778
Country : US
Telephone Number : 423-886-6979
Fax Number : 423-886-6962
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2021
Last Update Date : 11/15/2024

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