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General NPI Number Information
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NPI Number | 1306134341
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Entity Type | Individual
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Provider Name | BONNIE KATHLEEN CLARK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 197 E BROADWAY ST
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City | DANVILLE
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State | IN
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Zip | 46122-1803
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Country | US
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Telephone | 317-318-5271
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Fax |
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Provider Business Mailing Address
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Address Line | 197 E BROADWAY ST
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City | DANVILLE
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State | IN
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Zip | 46122-1803
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Country | US
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Telephone | 317-318-5271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010311
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License Number State | GA
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