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General NPI Number Information
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NPI Number | 1376241893
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Entity Type | Organization
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Legal Business Name | CLARKE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 75 E JERICHO TPKE
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City | MINEOLA
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State | NY
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Zip | 11501-3106
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Country | US
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Telephone | 631-338-0921
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Fax |
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Provider Business Mailing Address
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Address Line | 75 E JERICHO TPKE
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City | MINEOLA
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State | NY
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Zip | 11501-3106
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Country | US
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Telephone | 631-338-0921
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRENDAN CLARKE
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Credential | DPT
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Telephone | 516-568-5386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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