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NPI Code Detail

MEDICARE: MELISSA BETH CLARK MPT

MEDICARE: MELISSA BETH CLARK MPT
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
1225100000XPhysical TherapistPT3370MS

General Provider Information

NPI Number : 1447242797
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA BETH CLARK MPT
Provider Business Mailing Address
First Line : 23 COBBLE STONE DR
Second Line :
City : CALEDONIA
State : MS
Zip : 39740-5501
Country : US
Telephone Number : 662-241-4545
Fax Number : 662-241-4025
Provider Business Practice Location Address
First Line : 65 DUTCH LN
Second Line :
City : COLUMBUS
State : MS
Zip : 39702-5523
Country : US
Telephone Number : 662-241-4545
Fax Number : 662-241-4025
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/22/2005
Last Update Date : 07/08/2007

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Directions to “ MELISSA BETH CLARK MPT” Practice Location

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