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Individual
ALISHA SHAVON CLARK
Active
Individual
ALISHA SHAVON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT4135
MS
2251P0200X
Pediatric Physical Therapist
PT4135
MS
Other
Enumeration date
10/03/2013
Last updated
10/03/2013
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