MEDICARE: DR. ALYSIA ANN CLARKSON

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	6753	SC

General Provider Information

NPI Number	:	1356696439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALYSIA ANN CLARKSON

Provider Business Mailing Address
First Line	:	1134 TURKEY TROT DR
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8798
Country	:	US
Telephone Number	:	843-761-1480
Fax Number	:	843-761-1481

Provider Business Practice Location Address
First Line	:	1134 TURKEY TROT DR
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-8798
Country	:	US
Telephone Number	:	843-761-1480
Fax Number	:	843-761-1481

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	06/04/2020

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