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NPI Code Detail

MEDICARE: MERIDITH ELAINE CLARK LPTA

MEDICARE: MERIDITH ELAINE CLARK LPTA
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
1225200000XPhysical Therapy Assistant2306601578VA

General Provider Information

NPI Number : 1659385730
Entity Type Code : Individual
Provider Name (Legal Business Name) : MERIDITH ELAINE CLARK LPTA
Provider Business Mailing Address
First Line : 221 MANNINGS LN
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-4372
Country : US
Telephone Number : 757-333-6682
Fax Number :
Provider Business Practice Location Address
First Line : 1400 FORDHAM DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23464-5368
Country : US
Telephone Number : 757-361-3951
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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Directions to “ MERIDITH ELAINE CLARK LPTA” Practice Location

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