MEDICARE: ELIZABETH MCINNIS CLARK

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	13282	SC

General Provider Information

NPI Number	:	1619821113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MCINNIS CLARK

Provider Business Mailing Address
First Line	:	342 HARBOR ISLAND DR APT 310
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8915
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	142 SPORTSMAN ISLAND DR STE E
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8524
Country	:	US
Telephone Number	:	803-696-2174
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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