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General NPI Number Information
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NPI Number | 1689603904
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Entity Type | Individual
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Provider Name | SALLY O CLANCY PT
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 2205 JEFFERSON DAVIS DR
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City | OXFORD
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State | MS
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Zip | 38655-5221
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Country | US
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Telephone | 662-238-2800
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Fax | 662-238-2808
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Provider Business Mailing Address
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Address Line | PO BOX 1016
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City | OXFORD
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State | MS
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Zip | 38655-5221
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Country | US
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Telephone | 662-238-2800
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Fax | 662-238-2808
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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 | PT3472
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License Number State | MS
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