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Individual
STEPHANIE RENAE CLARK
Active
Individual
STEPHANIE RENAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2305207045
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538447560
—
VA
01
—
9400791
AETNA
VA
Enumeration date
07/25/2011
Last updated
02/13/2015
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