MEDICARE: CHANCZLOR CLARKE

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		FL

General Provider Information

NPI Number	:	1972453835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANCZLOR CLARKE

Provider Business Mailing Address
First Line	:	3500 NW 23RD CT
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33311-2662
Country	:	US
Telephone Number	:	754-214-0423
Fax Number	:

Provider Business Practice Location Address
First Line	:	15205 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-1810
Country	:	US
Telephone Number	:	813-605-4838
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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Directions to “ CHANCZLOR CLARKE ” Practice Location

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