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General NPI Number Information
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NPI Number | 1760160907
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Entity Type | Organization
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Legal Business Name | CLARK HOME AND HEALTH SERVICES PLC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 1302 SANDHILL DR
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City | DEWITT
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State | MI
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Zip | 48820-9550
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Country | US
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Telephone | 517-242-4042
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Fax | 517-237-6089
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Provider Business Mailing Address
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Address Line | 1302 SANDHILL DR
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City | DEWITT
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State | MI
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Zip | 48820-9550
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Country | US
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Telephone | 517-242-4042
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Fax | 517-237-6089
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | JONATHAN TENNYSON CLARK WISMER
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Credential | DPT, PT
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Telephone | 517-242-0425
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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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