| NPI | 1396290698 |
|---|---|
| Former Name | MADISEN CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT297866) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60655072) |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2020-12-30 |