MEDICARE: AUBREY CLARK

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	225700000X	Massage Therapist	MA96614	FL

General Provider Information

NPI Number	:	1831762285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUBREY CLARK

Provider Business Mailing Address
First Line	:	9409 IVY BROOK RUN APT 1310
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7768
Country	:	US
Telephone Number	:	239-888-6173
Fax Number	:

Provider Business Practice Location Address
First Line	:	9409 IVY BROOK RUN APT 1310
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33913-7768
Country	:	US
Telephone Number	:	239-888-6173
Fax Number	:

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

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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Directions to “ AUBREY CLARK ” Practice Location

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