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General NPI Number Information
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NPI Number | 1316787898
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Entity Type | Individual
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Provider Name | EMILY CLARK DPT
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Gender | Female
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Dates
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Enumeration Date | 05/30/2024
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 405 RACETRACK RD NE STE 101
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-3960
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Country | US
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Telephone | 850-863-4747
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Fax |
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Provider Business Mailing Address
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Address Line | 7617 QUAIL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35802-2830
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Country | US
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Telephone |
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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 | PT43404
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2-1372
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | CP050277T
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License Number State | TX
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