MEDICARE: BECKY ANN CLARK B.S., P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00000849	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0108459	OTHER	WA	LABOR & INDUSTRIES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225098411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BECKY ANN CLARK B.S., P.T.

Provider Business Mailing Address
First Line	:	21525 N LITTLE SPOKANE DR
Second Line	:
City	:	COLBERT
State	:	WA
Zip	:	99005-9478
Country	:	US
Telephone Number	:	509-466-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	12012 E MISSION AVE
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4887
Country	:	US
Telephone Number	:	509-413-1630
Fax Number	:	509-413-1673

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	04/09/2012

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