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General NPI Number Information
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NPI Number | 1679599229
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Entity Type | Individual
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Provider Name | JULIE CLARK PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 11/03/2024
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Provider Practice Location Address
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Address Line | 1111 STRATFORD AVE APT 319
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City | STRATFORD
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State | CT
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Zip | 06615-6379
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Country | US
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Telephone | 475-473-9955
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Fax |
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Provider Business Mailing Address
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Address Line | 318 NEW HAVEN AVE
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City | MILFORD
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State | CT
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Zip | 06460-6661
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Country | US
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Telephone | 203-874-0500
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Fax | 203-874-7751
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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 | 006162
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License Number State | CT
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