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General NPI Number Information
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NPI Number | 1376556399
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Entity Type | Individual
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Provider Name | TERRI CLARK PT
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 09/10/2008
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Provider Practice Location Address
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Address Line | 3331 S STATE ST
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2458
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Country | US
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Telephone | 269-982-1706
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Fax |
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Provider Business Mailing Address
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Address Line | 5542 JENNY CT
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City | COLOMA
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State | MI
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Zip | 49038-9360
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Country | US
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Telephone | 501-609-6561
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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 |
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License Number State |
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