Individual
CARRIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
586 LONE TREE DR, MT PLEASANT, SC 29464-8170
(843) 884-7880
(843) 884-6635
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3536
SC
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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