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NPI Code Detail

MEDICARE: LAURA BETH CLARK PT

MEDICARE: LAURA BETH CLARK PT
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 Therapist0400002590VT

General Provider Information

NPI Number : 1629295415
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA BETH CLARK PT
Provider Business Mailing Address
First Line : 426 INDUSTRIAL AVE
Second Line : SUITE 190
City : WILLISTON
State : VT
Zip : 05495-4448
Country : US
Telephone Number : 802-860-4360
Fax Number : 802-488-3160
Provider Business Practice Location Address
First Line : 426 INDUSTRIAL AVE
Second Line : SUITE 190
City : WILLISTON
State : VT
Zip : 05495-4448
Country : US
Telephone Number : 802-860-4360
Fax Number : 802-488-3160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2007
Last Update Date : 04/23/2015

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Directions to “ LAURA BETH CLARK PT” Practice Location

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