Individual
AMANDA J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1312 W ARCH HAVEN AVE BLDG 1320, SUITE E, BLOOMINGTON, IN 47403-2089
(812) 336-8406
(812) 336-8342
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-3251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05007177A
IN
Other
Enumeration date
11/15/2012
Last updated
02/16/2015
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