Individual
MS. LISA ARDELLE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2400 PORTRUSH DR, APT 8, SPARTANBURG, SC 29301-3334
(864) 285-4540
Mailing address
2400 PORTRUSH DR, APT 8, SPARTANBURG, SC 29301-3334
(864) 285-4540
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1240
NC
225200000X
Physical Therapy Assistant
1650
VA
225200000X
Physical Therapy Assistant
Primary
1803
SC
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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