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General NPI Number Information
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NPI Number | 1851538334
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Entity Type | Individual
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Provider Name | AMY SUE CLARK PT.DPT, CMT
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Gender | Female
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 4525 WEAVER PKWY SUITE 310
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City | WARRENVILLE
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State | IL
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Zip | 60555-0318
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Country | US
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Telephone | 917-428-0193
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 VILLAGE DR.
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City | COTTAGE GROVE
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State | OR
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Zip | 97424
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Country | US
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Telephone | 541-767-5260
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Fax | 541-767-2566
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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 | 2305205786
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1179646
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 62 028723
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1964
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License Number State | AK
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Taxonomy #5
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 06952
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License Number State | OR
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Taxonomy #6
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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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