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Individual
TERRI CLARK
Active
Individual
TERRI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0581
LICENSE #
AR
01
—
5501013139
MICHIGAN LICENSE
MI
Enumeration date
08/14/2006
Last updated
09/10/2008
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