| 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 |