Individual
SUSAN L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ASSOCIATES DEGREE
Contact information
Practice address
3019 COIT AVE NE, GRAND RAPIDS, MI 49505-3376
(616) 365-7761
Mailing address
3019 COIT AVE NE, GRAND RAPIDS, MI 49505-3376
(616) 365-7761
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502000487
MI
Other
Enumeration date
01/12/2011
Last updated
01/12/2011
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