NPI | 1558576553 |
---|---|
Former Name | SUSAN ELIZABETH CLARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO 2866) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: CO 2866) |
Enumeration Date | 2007-05-11 |
Last Update Date | 2018-03-17 |