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General NPI Number Information
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NPI Number | 1548992159
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Entity Type | Organization
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Legal Business Name | STEPH WHITE CLARK DPT LLC
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 917 GRANT AVE
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City | MEDFORD
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State | OR
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Zip | 97501-3407
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Country | US
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Telephone | 352-817-2512
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Fax |
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Provider Business Mailing Address
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Address Line | 917 GRANT AVE
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City | MEDFORD
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State | OR
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Zip | 97501-3407
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Country | US
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Telephone | 352-817-2512
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | DR. STEPHANIE MARIE CLARK
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Credential | PT, DPT, OCS
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Telephone | 352-817-2512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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