MEDICARE: EMILY ANDERSON CLARK PHYSICAL THERPIST

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	7611	CO

General Provider Information

NPI Number	:	1528074580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANDERSON CLARK PHYSICAL THERPIST

Provider Business Mailing Address
First Line	:	107 W 29TH ST
Second Line	:	SUITE 100
City	:	LOVELAND
State	:	CO
Zip	:	80538-2797
Country	:	US
Telephone Number	:	970-663-6142
Fax Number	:	970-635-3087

Provider Business Practice Location Address
First Line	:	2211 S COLLEGE AVE
Second Line	:	SUITE 300
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1489
Country	:	US
Telephone Number	:	970-663-6142
Fax Number	:	970-635-3087

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	03/16/2017

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